Background and Goal of Study
Despite small incisions, laparoscopic gynecological surgery can still cause severe postoperative pain in some patients[1]. However, what determines the intensity of postoperative pain in those patients remains elusive. The goal of this retrospective study was to determine the factors affecting postoperative analgesic requirements in patients undergoing laparoscopic surgery for benign gynecological diseases.

Materials and Methods
After obtaining the approval of the institutional ethical review board, the medical records of patients who received laparoscopic surgeries for benign gynecological diseases under general anesthesia from January 2014 through December 2016 were reviewed to collect patients’ profiles (age, body mass index (BMI) and ASA physical status), intraoperative variables (duration and type of surgery, intraoperative fentanyl and remifentanil doses, the use of intraoperative analgesics such as acetaminophen, diclofenac, flurbiprofen and wound infiltration of local anesthetics) and the use of rescue-analgesics over 24h after surgery. We performed univariate and multivariate logistic regression analyses with the stepwise selection technique to explore predictive factors of frequency of using rescue-analgesics.

Results and Discussion
All patients received continuous fentanyl infusion. Fentanyl bolus (20 μg) was given as a rescue-analgesia. Other analgesics such as flurbiprofen, diclofenac, acetaminophen, pentazocine and ibuprofen were also given as needed. After analyzing 183 patient records, 152 (83.0%) patients received rescue-analgesics at least once. Median number of rescue-analgesics given was three (25% and 75% percentile were 1 and 5, respectively). Among explanatory variables analyzed, patient’s age, BMI and hysterectomy were significantly associated with the moderate use of analgesics (≥ 3 times). Patient’s age (OR: 0.95, 95%CI: 0.91-0.99, p=0.02) and BMI (OR: 1.18, 95%CI: 1.06-1.32, p<0.01) were significantly correlated with the frequent use of analgesics (≥ 5 times). Other variables were not related to the frequency of rescue-analgesics. These data indicate that younger age and higher BMI are independent predictors for frequent analgesia requirements.

Conclusion
More aggressive intra- and post-operative analgesia should be considered for patients with younger ages and higher BMI undergoing laparoscopic surgery for benign gynecological disease.

References
1. Chio JB, et al. Int J Med Sci, 2016


08 / Factors affecting postoperative analgesic requirements in patients undergoing laparoscopic surgery for benign gynaecological diseases