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●●JOURNAL
●
JOURNALOF
OFPUBLIC
PUBLICHEALTH,
HEALTH,NURSING
NURSINGAND
ANDMEDICAL
MEDICALRESCUE
RESCUE●●No.1/2014
No. 1/2014(32-36)
●
32
The intensity of pain in female patients after
gynaecological surgeries
(Nasilenie bólu u pacjentek po operacjach ginekologicznych)
M Lewicka1, A, D, F, M Sulima1, B, I Brukwicka 2, C, B Stawarz 2, E
Abstract - Introduction. Gynaecological surgeries are performed on
women of all ages. The choice of the surgery method is dependent on
the disease entity, its progression, the location of lesions, the patient’s age and the surgical approach to the operated organ. The intensity of postoperative pain is directly related to the extent of the
surgical intervention, regardless of the patient’s individual features,
her genetic predispositions or social and environmental condition.
The duration of pain normally should not exceed two or three days
after the surgery.
The purpose of the study: The purpose of this paper was to analyse
the intensity of pain in female patients after gynaecological surgeries.
Materials and methods. The research was conducted in the Department of Gynaecology II of the Independent Public Hospital in Lublin
on 88 women who underwent gynaecological surgeries. The research
tool used was the Numerical Rating Scale - NRS. The database and
statistical analysis were managed in the STATISTICA 10.0 software
(StatSoft, Poland).
Results. The mean pain intensity within one day after the surgery was
higher (M=8) than on day three (M=4) and five (M=2). These differences were statistically significant (p<0.000001). The study has
shown that the patients whose surgery was abdominal felt significantly greater pain during the first 24 hours after the operation (M=8.00)
in comparison to those whose surgeries were vaginal (M=7.50) and
laparoscopic (M=6.00).
Conclusions. The highest intensity of pain in the group of patients
who underwent gynaecological surgeries falls on the first day after
the operation. Women after laparoscopic surgeries experience significantly less intense pain in the first and third postoperative day than
those after abdominal surgeries. It is advisable to provide analgesic
therapy to women operated on for gynaecological reasons in the
postoperative period. The application of an analgesic therapy has an
impact on the partial relief from pain in the majority of patients in the
early postoperative period.
czych chorego, uwarunkowań genetycznych, środowiskowych lub
socjalnych. Czas jego trwania zwykle nie powinien przekraczać
dwóch - trzech dób po operacji.
Cel pracy. Celem pracy była analiza nasilenia bólu u pacjentek po
operacjach ginekologicznych.
Materiał i metoda. Badania przeprowadzono w II Klinice Ginekologii
Samodzielnego Publicznego Szpitala Klinicznego nr 4 w Lublinie, w
grupie 88 kobiet po operacjach ginekologicznych. Zastosowane narzędzie badawcze stanowiła skala numeryczna nasilenia bólu (NRS
Numerical Rating Scale). Bazę danych i badania statystyczne przeprowadzono w oparciu o oprogramowanie komputerowe
STATISTICA 10.0 (StatSoft, Polska).
Wyniki. Wartość średnia nasilenia bólu w pierwszej dobie po operacji była większa (M=8) aniżeli w dobie trzeciej (M=4) i piątej (M=2).
Różnice te były istotne statystycznie (p<0,000001). Badania wykazały, że w pierwszej dobie po operacji pacjentki, które miały wykonaną
operację drogą brzuszną odczuwały zdecydowanie większe nasilenie
bólu (M=8,00) aniżeli badane, u których wykonano operację drogą
pochwową (M=7,50) lub laparoskopię (M=6,00).
Wnioski. Największe nasilenie dolegliwości bólowych w grupie pacjentek operowanych z powodów ginekologicznych występuje w
pierwszej dobie po operacji. Kobiety operowane metodą laparoskopii
odczuwają istotnie mniejsze nasilenie dolegliwości bólowych w
pierwszej i trzeciej dobie pooperacyjnej aniżeli chore operowane
drogą brzuszną. Celowe jest prowadzenie terapii przeciwbólowej w
okresie pooperacyjnym w grupie kobiet operowanych z powodów
ginekologicznych. Zastosowanie terapii przeciwbólowej ma wpływ
na częściowe zniesienie bólu u większości pacjentek we wczesnym
okresie pooperacyjnym.
Key words - pain, gynaecological surgeries, postoperative period.
1. Department of Obstetrics, Gynaecology and ObstetricalGynaecological Nursing Faculty of Nursing and Health Sciences,
Medical University, Lublin;
2. Institute of Health Protection, The Bronisław Markiewicz State
Higher School of Technology and Economics in Jarosław
Streszczenie – Wprowadzenie. Operacje ginekologiczne wykonywane są u kobiet w każdym wieku. Wybór drogi operacji uzależniony
jest od jednostki chorobowej, zaawansowania choroby, lokalizacji
zmian, wieku pacjentki oraz warunków dostępu do operowanego
narządu. Nasilenie bólu pooperacyjnego ma bezpośredni związek z
rozmiarem interwencji chirurgicznej, niezależnie od cech osobni-
Słowa kluczowe - ból, operacje ginekologiczne, okres pooperacyjny.
Author Affiliations:
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Magdalena Lewicka MD, PhD, Department of Midwifery, Gynaecology and Gynaecological Nursing; Faculty of Nursing and Health
Sciences, Medical University of Lublin, Chodźki 6 Str., PL-20-093
Lublin, Poland, e-mail: [email protected]
I. INTRODUCTION
ynaecological surgeries are performed on women of all
ages. The choice of the surgery method is dependent on
the disease entity, its progression, the location of lesions,
the patient’s age and the surgical approach to the operated
organ [1,2].
Pain, as defined by the International Association for the
Study of Pain, is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage [3,4,5].
Pain is a subjective sensation and in order to assess it, one
needs to have the information on the following: the time and
duration of the patient’s pain, its intensity, location, nature as
well as factors that intensify it or relieve it and the patient’s
expectations towards the analgesic treatment [6,7,8].
Postoperative pain is a severe pain experienced after the anaesthetic wears off. It is related to physical (nociception) and
emotional components (suffering). The intensity of postoperative pain is directly related to the extent of the surgical
intervention, regardless of the patient’s individual features, her
genetic predispositions or social and environmental condition.
The duration of pain normally should not exceed two or three
days after the surgery
[9,10].
The correct selection of postoperative analgesia reduces the
hormonal and metabolic stress, minimises the risk of complications, decreases the costs of the treatment and facilitates recovery [11-14].
The purpose of the study
The aim of the study was to analyse the intensity of pain in
women after gynaecological surgeries.
G
II.
33
MATERIALS AND METHODS
The study was conducted in the Department of Gynaecology
II of the Independent Public Hospital in Lublin on 88 women
who underwent gynaecological surgeries. Their mean age was
41.11 ± 12.73 years old. 31.82% of the patients (n=28) were
women of 35 or less, whereas 37.5% of them (n=33) were between 36 and 45. The remaining subgroup (n=27; 30.68%)
were 46 or older. Almost a half of the respondents had higher
education (n=43; 48.86%), while 29.55% of them (n=26) had
secondary education and 21.59% (n=19) – primary education.
The studied patients lived predominantly in cities and towns
(n=54; 61.36%), with the remaining 38.64% (n=34) residing in
villages. Almost two thirds of the studied patients (n=55;
62.50%) underwent abdominal surgeries (laparotomy). Other
operation methods were vaginal (n=16; 18.18%) and laparoscopic (n=17; 19.32%).
The research tool used was the Numerical Rating Scale –
NRS. Patients were supposed to rate their pain from 0 to 10
(with 0 being “no pain” and 10 being “maximum pain”). The
authors have also used their own questionnaire developed in
order to obtain the characteristics of the study group.
Statistical analysis
The results obtained were analysed statistically. The values
of the parameters analysed were calculated to obtain mean,
median and standard deviation or – in the case of nonmeasurable ones – cardinality and percentage. The normality
of distribution related to the measurable data was assessed
using the Shapiro-Wilk test. In the case of unrelated qualitative
features, the chi-squared test of homogeneity was used in order
to detect the differences between the subgroups analysed. In
order to analyse the correlation between the characteristics
studied, the chi-squared test of independence was applied.
While the Mann–Whitney U was utilised to compare two independent subgroups, for comparing more than two groups the
the Kruskal–Wallis one-way analysis of variance was used.
The significance level indicating statistically significant differences was assumed to be p<0.05. The database and statistical
analysis were managed in the STATISTICA 10.0 software
(StatSoft, Poland).
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
1
6.95
2.61
8
8
20
3
3.99
2.09
4
4
22
5
2.16
1.38
2
2
42
Statistical analysis: Chi-squared ANOVA=130.75;
p<0.000001
Table 1 presents mean values of pain intensity 1, 3 and 5 days
after the respective surgeries of the studied women. On the
basis of the data analysis, the mean pain intensity was found to
be higher in the first 24 hours after the surgery (M=8) than on
day 3 (M=4) and day 5 (M=2). These differences were statistically significant (p<0.000001).
Table 3. Painkillers applied postoperatively to the group of
studied patients
Table 2. The correlation between the intensity of pain in the
postoperative period and the surgery method
47
44
68
13
14
14
200
23.5%
22.%
34%
6.5%
7%
7%
100%
12
12
26
54
0
1
105
11.%
11.%
24.7%
51.4%
0.0%
0.9%
100%
6
0
4
10
0
0
20
30.0%
0.0%
20.0%
50.0%
0.0%
0.0%
100%
65
56
98
77
14
15
325
20.%
17.%
30.1%
23.%
4.3%
4.6%
100%
1
Day 1 after the surgery
Surgery method
mean
median
standard deviation
abdominal
vaginal
laparoscopic
7.49
8.00
2.55
6.44
7.50
2.42
3
5.71
6.00
2.59
Statistical analysis: H =9.56; p=0.008
Day 3 after the surgery
Day 5 after the surgery
standard deviation
2.35
2.00
1.54
abdominal
1.94
2.00
0.85
vaginal
1.76
2.00
1.15
laparoscopic
Statistical analysis: H =0.96; p=0.62
5
TOTAL
Surgery method mean median standard deviation
4.49
4.00
2.14
abdominal
3.31
4.00
1.66
vaginal
3.00
3.00
1.80
laparoscopic
Statistical analysis: H =8.69; p=0.01
Surgery method mean median
TOTAL
mode
quantity
dolantine
mode
morphine
median
diclofenac
standard
deviation
perfalgan
mean
ketonal
Days
after the
surgery
pyralgin
Table 1. The assessment of postoperative pain intensity (NRS)
in the studied group
Table 2 shows the correlation between the intensity of pain in
the postoperative period and the surgery method. The study
has shown that patients who underwent abdominal surgeries
felt, on the 1st day after the surgery, significantly more severe
pain (M=8.00) than those operated on vaginally (M=7.50) or
laparoscopically (M=6.00). These differences were discovered
to be statistically significant (p=0.008). Furthermore, on the
basis of the analysis of the results, statistically significant correlations (p=0.01) were found between the pain intensity and
the surgery method for the day 3 after the operation. However,
the statistical analysis did not indicate towards any statistically
significant differences (p=0.62) between the pain intensity and
the surgery method for the day 5 after the operation. The mean
value of pain intensity was 2.00 in all the subgroups, i.e.
among the patients who underwent abdominal, vaginal and
laparoscopic surgeries.
Days after
the surgery
III. RESULTS
34
A vast majority of the studied patients (n=79; 89.77%) were
subjected to an analgesic therapy in the postoperative period.
The remaining patients (n=9; 10.23%) claimed to never have
undergone a therapy of that kind. The study shows that
42.05% of the women (n=37) felt a partial relief from pain.
32.95% of the patients (n=29) did not experience a significant
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
relief from pain despite undergoing an analgesic therapy,
whereas in 26.00% of the cases (n=22), the pain did not withdraw although painkillers were applied. The most commonly
used drug in the first 24 hours after the surgeries was perfalgan
(n=68; 34.00%). On day 3 and 5, diclofenac was applied most
frequently (n=54; 51.43% and n=10; 50.00%, respectively) –
see Table 3.
IV. DISCUSSION
Gynaecological diseases are the most common cause of
hospitalisation at gynaecology departments. Most patients find
it exceptionally difficult, especially in the cases when the only
form of treatment possible is a surgery, which is related to
many complications, including pain [1, 2]. The study has
shown that 62.50% of the patients in the studied group underwent abdominal surgeries (laparotomy), 18.18% of them had
vaginal surgery and 19.32% - a laparoscopic surgery.
The sensation of pain is an individual characteristic of every
human being. The factors influencing the sensation of pain are:
age, sex, race, pain threshold, emotionality, spirituality, life
history and history of the relations with the environment [1117]. Women, as compared to men, suffer more from acute
postoperative pain and handle chronic pain worse. Women’s
pain threshold gradually increases as the time after the surgical
trauma passes, which may make it necessary to modify the
painkiller dose. Postoperative pain is an acute pain accompanied by hypersensitivity. A patient feels it after the intraoperative analgesia wears off – it consists in an unpleasant sensory
and emotional sensation. It reaches its highest intensity during
the first and the second day after the surgery, whereas on days
3 and 4 after the operation, the intensity drops significantly
[18-20]. The study has shown that the patients who were operated on abdominally experienced significantly more intense
pain on the postoperative days 1 and 3 as compared to those
who underwent vaginal and laparoscopic surgeries.
The aim of analgesic treatment after gynaecological operations is the subjective improvement of the patient’s somatic
and mental well-being [12,21,22]. The details of an analgesic
therapy should be established on an individual basis in each
case, taking into consideration factors such as: the intensity
and duration of preoperative pain, the location of the pain, the
duration and extent of the surgery, the patient’s age and body
mass, the data on possible drug abuse and tolerance for opioids, cultural and psychological factors [13,14,22,23]. Proper
analgesia decreases pain and improves the patient’s quality of
life [10,11,12,19,20,21]. Analgesic postoperative treatment in
gynaecology is based on the algorithm developed by the specialists from the Polish Association for the Study of Pain and
the Polish Gynaecological Society [3,12,19]. The study has
35
shown that a vast majority of the patients studied (89.77%)
underwent an analgesic therapy after the surgery. The research
also indicates that 42.05% of the patients felt partially relieved
of pain, whereas 32.95% of them did not experience a significant relief from pain despite having undergone an analgesic
therapy. 26.00% of the studied women felt no relief from pain
in spite of taking painkillers. The study has also shown that the
medication used most commonly during the first 24 hours after
surgery was perfalgan, whereas on days 3 and 5 it was diclofenac.
The assessment of pain intensity in women treated for gynaecological reasons should be a permanent element of treatment and nursing, which could improve patients’ quality of life
and comfort after surgeries. According to Sochacka et al. [4],
interdisciplinary cooperation of different specialists should be
implemented in order to fight pain.
V. CONCLUSIONS
1. The greatest intensity of postoperative pain in patients who
have undergone a gynaecological surgery falls on the first
24 hours after the operation.
2. Women after laparoscopic surgeries experience significantly
less severe pain on the first and third day after the operation in comparison to those operated on abdominally.
3. It is advisable to provide analgesic therapy to women operated on for gynaecological reasons in the postoperative
period. The application of an analgesic therapy has an impact on the partial relief from pain in the majority of patients in the early postoperative period.
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