Effects of closed suction drainage in reducing pain after laparoscopic-assisted vaginal hysterectomy

Study Objective. To estimate whether closed suction drainage of the pelvis after laparoscopic-assisted vaginal hysterectomy (LAVH) reduces the frequency and intensity of shoulder-tip, abdominal, and back pain. Design. Prospective, randomized study (Canadian Task Force classification 1). Setting. Teaching medical center. Patients. One hundred sixty-four women. Intervention. LAVH. Measurements and Main Results. For group 1 (80 women), closed suction (Jackson-Pratt) drains were inserted into the peritoneal cavity and cul-de-sac, whereas for group 2 (84), no drains were placed. Shoulder-tip, abdominal, and back pain were evaluated by visual analog scores (VAS) 3, 24, and 48 hours after surgery. The frequency of shoulder-tip pain was significantly lower in group 1 at 24 hours (23% vs 40%, p = 0.013) and 48 hours (9% vs 21%, p = 0.024; VAS scores at 24 hrs 2.2 ± 1.1 vs 3.8 ± 1.3, p = 0.010; VAS scores at 48 hours 1.5 ± 1.0 vs 2.5 ± 1.2, p = 0.018). At 48 hours fewer women in group 1 experienced abdominal pain (31% vs 50%, p = 0.039; VAS scores 2.0 ± 1.1 vs 4.0 ± 1.3, p = 0.007). No statistically significant differences in frequency and VAS scores for back pain were found at any time. The quantity of oral analgesics was greater for group 2 than for group 1 (12.4 ± 1.6 vs 9.0 ± 1.4, p <0.001). Economic evaluation of analgesic requirements and material costs for the two groups showed that simple analgesics were more cost-effective than closed suction drainage in the treatment of pain. Conclusion. Closed suction drains may reduce the frequency and intensity of shoulder-tip and abdominal pain and postoperative analgesia requirements after LAVH, but simple oral analgesics are more cost effective.