Abdominal Hysterectomy 2006

Systematic review of the literature from 1966 – January 2004 using MEDLINE and EmBASE, following…

Literature search

• Systematic review of the literature from 1966–January 2004 using MEDLINE and EmBASE, following the protocol of the Cochrane Collaboration
• Inclusion of randomised studies assessing analgesic interventions in hysterectomy and reporting pain on a linear analogue scale
• Identification of 308 studies of peri-operative interventions for postoperative pain following hysterectomy
• 187 studies included
• 121 studies excluded
• Most common reason for exclusion was the absence of postoperative pain scores (61 studies).

Explanation for the focus on abdominal over vaginal hysterectomy

• The significant majority of studies found in the literature search were in abdominal hysterectomy, with the exception of:
  • two studies in vaginal hysterectomy (Nelskyla 1997, Shen 2003) (treated as transferable evidence)
  • four studies in a mixed abdominal and vaginal hysterectomy population (Beck 2000a, Hegi 2004, Kopp 2000, Mais 1997) (treated as specific evidence)
  • nine studies comparing laparoscopically-assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (Ellstrom 1998, Falcone 1999, Garry 2004, Howard 1993, Hwang 2002, Marana 1991,, Olsson 1996, Schutz 2002) (see Operative Techniques section)
• The studies showed that LAVH is associated with significantly lower postoperative pain scores than abdominal hysterectomy: meta-analyses showed a reduction of up to 29 mm at 48 h on a 100-mm VAS (p<0.00001) (see Operative Techniques section)
• In light of the different pain profiles for LAVH and abdominal hysterectomy, and the absence of studies in LAVH, these procedures will be assessed separately, and an analysis of analgesia for controlling postoperative pain in LAVH conducted when more studies are available

Transferable evidence
As for all of the procedures in PROSPECT, abdominal hysterectomy-specific evidence was supplemented with transferable evidence, the majority of which was from other major gynaecological and abdominal procedures.