Postoperative Pain and Analgesic Requirements Following Hysteroscopic
Endometrial Ablation Surgery.
Shireen Ahmad, M.D., Amit Mehta, M.D., Robert J. McCarthy, Pharm. D.
Northwestern University Feinberg School of Medicine, Chicago, Il

Introduction: Hysteroscopy is one of the oldest endoscopic procedures. Bozzini in 1807 performed the first hystereoscopic examination of the uterus. Hysteroscopic radio frequency ablation of endometrial tissue has been used to treat dysfunctional uterine bleeding since the early 1980’s. Recently, a hysteroscopic thermal ablation technique using a warmed saline filled ballon has replaced the radiofrequency ablative methods for treating dysfunction uterine bleeding. Because this newer method potentially produces thermal
injury to a greater area of the uterus, we hypohtesized that patient that underwent hysteroscopic thermal ablations were experiencing more pain than those who had other types of operative hysteroscopy. The purpose of this study was to compare postoperative analgesic requirements, pain scores and discharge times in patients who underwent hysteroscopic thermal ablations compared to those undergoing other types of
operative hysteroscopies.
Methods: Following IRB approval, a retrospective review of records of 43 patients who underwent hysteroscopic surgery was performed. Demographic, operative (anesthetic and analgesics agents), verbal rating of pain scores (VRPS) on admission and discharge from the PACU, analgesics administered in the PACU and ASU as well as the time to hospital discharge were recorded. Patient characteristics, duration of sugery, intraoperative fentanyl equivalents, postoperative analgesic requirements (morphine equivalents)
and time to discharge were compared between groups using the Mann Whitney U test. VRPS were compared from admission to discharge within groups using Freidman’s one way ANOVA. A P<0.05 was required to reject the null hypothesis.
Results: Of the 43 cases reviewed, 33 underwent hysteroscopic procedures under general anesthesia (table). Patient characteristics, duration of surgery, intraoperative anesthetics including fentanyl analgesia equivalents, and VRPS at PACU admission were comparable between groups. Pain at discharge was lower in patients undergoing non-ablative procedures despite receiving less (P=0.047) postoperative analgesia.

Conclusion: Adequate postoperative pain management control is very important following outpatient surgery since inadequate analgesia can result in postoperative nausea and vomiting, delayed discharge, unanticipated admission and significant patient dissatisfaction. The important finding of this study is that paatients undergoing hysteroscopic ablation experienced considerably more postoperative pain and greater opioid requirement than those who undergo hysteroscopic resection or polypectomy. In addition, these patients had longer postoperative hospital stays. These findings indicate that further investigation is
warranted to determine the best method for anesthesia and postoperative analgesia for endometrial ablation surgery.

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