Modern Postoperative Pain to the Treatment Approaches in Oncogynecology


I.I. Khusainova , A.Zh. Bayalieva , M.К. Browne

Kazan State Medical University, Kazan, Russia

For correspondence: Aynagul Zh. Bayalieva — Doct. of Med. Sci., Docent, Head of the Department of Anesthesiology and Reanimatology, disaster medicine of Kazan State Medical University, Kazan, Russia; e-mail:

For citation: Khusainova II, Bayalieva AZh, Browne MК. Modern Postoperative Pain to the Treatment Approaches in Oncogynecology. Intensive Care Herald. 2017;4:13–18. DOI:10.21320/1818-474X-2017-4-13-18

Effective postoperative analgesia is one of the successful rehabilitation conditions. Mechanisms of postoperative pain have been being studied by now, and more new analgesics and anesthesia techniques are introduced. The range of surgical interventions in oncogynecology is wide: from minimally invasive laparoscopic operations to radical hysterectomies involving healthy tissues and removal of regional lymph nodes. Postoperative pain following radical hysterectomy with an intensity of more than 6 on visual analogue scale (VAS) requires multimodal pain therapy. Inadequate pain management leads to its transformation to a chronic condition, a neuropathic pain, associated with not fully reversible changes in patient’s brain. This article is based on the results of a systematic literature review developed by PROSPECT (cooperation of surgeons and anaesthesiologists in developing guidelines for specific procedures and manipulations). It deals with optimization of pain management highlighting new post-operative care principles.

Keywords: postoperative pain, balanced multimodal analgesia

Received: 09.06.2017

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  1. Hahnenkamp K., Herroeder S., Hollmann M.W. Regional anaesthesia, local anaesthetics and the surgical stress response. Best Pract. Res. Clin. Anaesthesiol. 2004;18(3): 509–527.
  2. Kehlet H. The stress response to surgery: release mechanisms and the modifying effect of pain relief. Acta Scand. Suppl. 1989; 550: 22–28.
  3. Tetzlaff J.E. Cousins and Bridenbaugh’s Neural Blockade in Clinical Anesthesia and Pain Medicine. Mayo Clin. Proc. 2010; 85(7): e51. doi: 4065/mcp.2010.0230.
  4. Wall & Melzack’s Textbook of Pain. 6th URL: Accessed September 23, 2017.
  5. Misiołek H., Cettler M., Woroń J., Wordliczek J., Dobrogowski J., Mayzner-Zawadzka E. The 2014 guidelines for post-operative pain management. Anaesthesiol. Intensive Ther. 2014; 46(4): 221–244. doi: 5603/AIT.2014.0041.
  6. Griensven H., Strong J., Unruh A. Pain. A Textbook for Health Professionals. 2nd Elsevier. Churchil Livingstone, 2014: 430– 431.
  7. Овечкин А.М., Политов М.Е. Послеоперационное обезболивание с точки зрения доказательной медицины. Вестник интенсивной терапии. 2016; 2: 51–60. [Ovechkin A.M. Politov M.E. Postoperative analgesia from evidence based medicine. Intensive Care Herald. 2016; 2: 51–60. (In Russ)]
  8. Овечкин А.М. Послеоперационная боль и обезболивание: современное состояние проблемы. Медицина неотложных состояний. 2011; 6: 37. [Ovechkin A.M. Postoperative pain and anesthesia: the current state of the problem. Emergency medicine. 2011; 6: 37. (In Russ)]
  9. Осипова Н.А., Петрова В.В., Береснев В.А., Митрофанов С.В. Современные средства и методы анестезии и анальгезии в большой хирургии. Регионарная анестезия и лечение боли: тематический сборник. Москва-Тверь, 2004; 7–16. [Osipova N.A, Petrova V.V., Beresnev V.A., Mitrofanov S.V. Modern Means and Methods of Anesthesia and Analgesia in the General Surgery. Regional Anesthesia and Pain Management. Thematic Collection. Moscow-Tver, 2004; 7–16. (In Russ)]
  10. Rawal N., Andres J., Fischer B.J. et al. Postoperative pain management — good clinical practice. General recommendations and principles for successful pain management. General recommendations and principles for successful pain management. Produced with the consultation with the Europeans Society of Regional Anaesthesia and Pain Therapy. 2005. URL: http://
  11. Осипова Н.А., Абузарова Г.Р., Петрова В.В. Принципы применения анальгетических средств при острой и хронической боли. М.: ФГБУ «МНИОИ им. П.А. Герцена Минздравсоцразвития России», 2010. [Osipova N.A., Abuzarova G.R., Petrova V.V. Principles of using analgesics for acute and chronic pain. Moscow: A. Herzen Moscow Oncology Research Institute (MNIOI P.A. Gertsena), Ministry of Health and Social Development of Russia, 2010. (In Russ)]
  12. Dolin S.J., Cashman J.N., Bland J.M. Effectiveness of acute postoperative pain management: I. Evidence from published data. J. Anaesth. 2002; 89(3): 409–423.
  13. Кукушкин М.Л. Общая патология боли: руководство для врачей. Медицина, 2004. [Kukushkin M.L. General pathology of pain. A guide for doctors. Medicine, 2004. (In Russ)]
  14. Wei H., Karimaa M., Korjamo T., Koivisto A., Pertovaara A. Transient receptor potential ankyrin 1 ion channel contributes to guarding pain and mechanical hypersensitivity in a rat model of postoperative pain. 2012; 117(1): 137–148. doi: 10.1097/ALN.0b013e31825adb0e.
  15. Спасова А.П., Барышева О.Ю. Методы объективизации боли и связанных с нею расстройств. Министерство образования и науки РФ, ФГБОУ ВПО «Петрозаводский гос. ун-т». Петрозаводск: Издательство ПетрГУ, 2015 [Spasova A.P., Barysheva O.Yu. Methods of Objectivization of Pain and Related Disorders. Ministry of Education and Science Russian Federation, Federal State Budget Educated Institution of higher continuous education Petrozavodsk State University. Petrozavodsk: Publishing house PetrSU, 2015. (In Russ)]
  16. Голуб И.Е., Сорокина Л.В. Хирургический стресс и обезболивание. Иркутск: ИГМУ, [Golub I.E., Sorokina L.V. Surgical stress and anesthesia. Irkutsk State Medical University (ISMU), 2005. (In Russ)]
  17. Овечкин А.М. Влияние регионарной анестезии и анальгезии на результаты хирургического лечения. Регионарная анестезия и лечение острой боли. 2015; 1: 45–54. [Ovechkin A.M. The effect of regional anesthesia and analgesia on the results of surgical treatment. Regional anesthesia and treatment of acute pain. 2015; 1: 45–54. (In Russ)]
  18. Harsoor S. Emerging concepts in post-operative pain management. Indian J. Anaesth. 2011; 55(2): 101–103. doi: 4103/0019-5049.79872.
  19. Mamittz S., Kohler C. Current therapy of patients with endometrial carcinoma. A critical review. Strahlenther. Onkol. 2012; 188(1): 12–20. doi: 1007/s00066-011-0004-0.
  20. Lim P.C., Crane J.T., English E.J. et al. Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign Int. J. Gynaecol. Obstet. Off Organ. Int. Fed. Gynaecol. Obstet. 2016; 133(3): 359–364. doi: 10.1016/j.ijgo.2015.11.010.
  21. Бохман Я.В. Руководство по онкогинекологии. М.: Книга по требованию, 2012. [Bohman Ya.V. Manual on oncogy Moscow: The book on Demand, 2012. (In Russ)]. URL:
  22. Coughlin S.M., Karanicolas P.J., Emmerton-Coughlin H.M., Kanbur B., Kanbur S., Colquhoun P.H. Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and metaanalysis. Endosc. 2010; 24(12): 3167–3176. doi: 10.1007/s00464-010-1111-1.
  23. Hong J.Y., Lim K.T. Effect of preemptive epidural analgesia on cytokine response and postoperative pain in laparoscopic radical hysterectomy for cervical Reg. Anesth. Pain Med. 2008; 33(1): 44–51.
  24. Azari L., Santoso J.T., Osborne S.E. Optimal pain management in total abdominal hysterectomy. Gynecol. Surv. 2013; 68(3): 215–227. doi: 10.1097/OGX.0b013e31827f5119.
  25. Горобец Е.С., Груздев Е.В., Зотов А.В., Типисев Д.А., Шин А.Р. Концепция мультимодальной комбинированной анестезии и безопасность травматичных операций. Регионарная анестезия и лечение острой боли. 2009; 1: 39–45 [Gorobets E.S., Gruzdev E.V., Zotov A.V., Tipisev D.A., Shin A.R. The concept of multimodal combined anesthesia and the safety of traumatic surgeries. Regional. anesthesia and treatment of acute pain. 2009; 1: 39–45. (In Russ)]
  26. Наумов А.В., Семенов П.А., Мендель О.И. Стратегия ведения послеоперационного болевого синдрома: фокус на мультимодальную анальгезию. Consilium 2010; 12(8): 104–107. [Naumov A.V., Semenov P.A., Mendel O.I. The strategy of conducting postoperative pain syndrome: focus on multimodal analgesia. Consilium Medicum. 2010; 12(8): 104–107. (In Russ)]
  27. Страчунский Л.С. Нестероидные противовоспалительные средства: методическое пособие. Смоленск: СГМА, 2008. [Strachunsky L.S. Non-steroidal anti-inflammatory drugs, methodical manual. Smolensk State Medical Academy (SGMA), 2008. (In Russ)]
  28. Bekawi M.S., El Wakeel L.M., Al Taher W.M., Mageed W.M. Clinical study evaluating pregabalin efficacy and tolerability for pain management in patients undergoing laparoscopic Clin. J. Pain. 2014; 30(11): 944–952. doi: 10.1097/ AJP.0000000000000060.
  29. Buck M., Blumer J. Opioids and other analgesics: Adverse effects in the intensive care Crit. Care Clin. 1991; 7: 615–637.
  30. Buvanendran A., Kroin J.S. Multimodal analgesia for controlling acute postoperative pain.Curr. Opin. Anaesthesiol. 2009; 22(5): 588–593. doi: 1097/ACO.0b013e328330373a.
  31. Horlocker T.T., Kopp S.L., Pagnano M.W., Hebl J.R. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J. Am. Acad. Orthop. Surg. 2006; 14(3): 126–135.
  32. Goucke C.R., Jackson T., Morriss W., Royle J. Essential pain management: an educational program for health care workers. World Surg. 2015; 39(4): 865–870. doi: 10.1007/s00268-014- 2635-7.
  33. Jain A.K., Kumar S., Tyagi A. Practice trends in use of morphine for control of intraoperative pain: An audit. J. Anaesthesiol. Clin. Pharmacol. 2012; 28(1): 62–65. doi: 10.4103/0970- 9185.92440.
  34. Jørgensen H., Wetterslev J., Møiniche S., Dahl J.B. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst. 2000; 4: CD001893. doi: 10.1002/14651858.CD001893.
  35. Correll D.J., Vlassakov K.V., Kissin I. No evidence of real progress in treatment of acute pain. Journal of pain research. 2014; 7: 199–210. doi: 2147/JPR.S60842.
  36. Alimian M., Pournajafian A., Kholdebarin A., Ghodraty M., Rokhtabnak F., Yazdkhasti P. Analgesic effects of paracetamol and morphine after elective laparotomy surgeries. Pain Med. 2014; 4(2): e12912. doi: 10.5812/aapm.12912.
  37. Gerbershaden M.U. Procedure-specific postoperative pain treatment. 2015. URL:
  38. Kehlet H. Labat lecture 2005: surgical stress and postoperative outcome-from here to where? Anesth. Pain Med. 2006; 31(1): 47–52. doi: 10.1016/j.rapm.2005.10.005.
  39. Kehlet H., Werner M., Perkins F. Balanced analgesia: what is it and what are its advantages in postoperative pain? Drugs. 1999; 58(5): 793–797.