MODERN POSSIBILITIES OF CHRONIC PAIN PREVENTION AFTER ABDOMINAL HYSTERECTOMIES: RETROSPECTIVE-PROSPECTIVE COHORT STUDY

Original study. Yuri Semenyuk Rivne Regional Clinical Hospital, anesthetist of the Department of Anesthesiology and Intensive Care, Rivne, Ukraine; Danylo Halytsky Lviv National Medical University, assistant of the Department of Anesthesiology and Intensive Care, Lviv, Ukraine Background. The frequency of pain chronification after abdominal hysterectomies varies from 10 to 50 %. However, it is not known for sure how much the surgery itself and the quality of anesthesia cause or prevent it. The study aimed to investigate the effect of preoperative hypovitaminosis of cobalamin and increased concentration of glycosylated hemoglobin on the formation of chronic postoperative pain and to study the possibilities of chronic pain prevention after abdominal hysterectomy. Materials and methods. A retrospective-prospective cohort study included 54 medical records of the patients who underwent abdominal hysterectomy via Pfannenstiel incision. Medical records were divided into two groups according to the type of anesthesia. General anesthesia was used in both groups. In addition, epidural anesthesia with catheterization was performed preoperatively in group I. There was no regional component in group II. Study stages: 24 hours (h24), 48 hours (h48), 72 hours (h72), 90 days (d90) and 120 days (d120) after surgery. The probability of developing chronic neuropathic pain (LANSS and DN4 scales), the daily need for morphine, the dosage of dexketoprofen and paracetamol, and the preoperative level of cobalamin and glycosylated hemoglobin were evaluated. Results and discussion. It was found that the need for morphine at the h24 and h48 stages was higher in the II group and was 2.5 [0;10.0] mg/day in the I group, and 7.5 [5.0; 10.0] mg/day in the II group. At the h48 stage a tendency to higher doses of dexketoprofen prescription was in the II group – 100 [75; 150] mg/day, while in the I group – 50 [0; 150] mg/day (P>0.05). The probability of the neuropathic chronic pain formation was higher in the II group – at the d90 and d120 stages, 7 and 6 patients in the I group and 13 and 12 patients in the II group, respectively, had signs of chronic pain. (P<0.05). All four patients of both groups with cobalamin deficiency and/or with a high level of glycosylated hemoglobin had signs of pain chronification at stages d90 and d120. (P>0.05). Conclusion. Chronic pain occurred more frequently in group II, and all patients with cobalamin hypovitaminosis and/or high level of glycosylated hemoglobin had signs of chronic pain. All these give information about alternative and additional ways of chronic pain preventing with glycemic control and correction of hypovitaminosis B12 in addition to the use of regional anesthesia in abdominal hysterectomies