Postoperative Pain and Analgesic Requirements in Minimally Invasive Versus Open Gynaecological Procedures
DOI:
https://doi.org/10.66687/jebmr.2.02.2026.27Abstract
Background: One of the frequent problems after gynaecological surgery is postoperative pain which can have a significant impact on the patient's recovery, hospital stay and overall satisfaction. The use of minimally invasive gynaecological procedures such as Laparoscopic Surgery is growing in popularity as they have a smaller incision, less tissue trauma and quicker recovery time when compared to traditional open surgery. But, there are clinically significant differences between the two surgical techniques in terms of intensity of postoperative pain and the amount of analgesics needed to manage it effectively for patient care and better postoperative outcomes.
Objectives: To determine whether there is a difference in the severity of postoperative pain and need for analgesics between MIF and open gynaecologic surgeries. Study was also conducted to assess the difference in the postoperative recovery, duration of hospital stay and early postoperative outcome of the two surgical methods, for patient handling and recovery to be safer and more effective.
Methods: Comparative cross-sectional study conducted in the Department of Gynecology and Obstetrics at a tertiary care centre over six months. 250 patients were included who underwent gynecological surgery. Patients were split into two groups: minimally invasive and open gynecological surgeries. Samples were calculated based on the formula recommended by WHO. Visual Analogue Scale (VAS) was used to determine the postoperative pain at 6, 12 and 24 hours. Other data such as analgesics requirements, length of hospital stay and postoperative complications were also collected and analyzed in SPSS version 26.
Results: Patients who had gone through minimally invasive procedures had significantly lower pain scores after the surgery, as opposed to the patients who had undergone open surgeries. Opioid analgesics use was significantly less in the minimally invasive group. Furthermore, the minimally invasive group had shorter hospital stays along with earlier mobilisation. Higher pain intensity was found in patients who underwent open gynecological surgery, as well as in those who used more analgesics after the surgery.
Conclusions: Minimally invasive gynecological procedures have been found to have less postoperative pain and require a smaller number of analgesics than open surgeries. These techniques result in quicker recovery, less hospital stay and increased comfort for the patient, and are a preferred surgical approach wherever possible.
Keywords: Postoperative pain; gynecological surgery; minimally invasive surgery; open surgery; analgesic requirement
References
Abu-Zaid A, Alomar O, AlNaim NF, Abualsaud FS, Jamjoom MZ, AlNaim LF, et al. Preemptive pregabalin for postoperative analgesia during minimally invasive hysterectomy: a systematic review and meta-analysis of randomized controlled trials. Obstetrics & Gynecology Science. 2022;65(2):133-144.
Giampaolino P, Della Corte L, Mercorio A, Bruzzese D, Coviello A, Grasso G, et al. Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study. Updates in Surgery. 2022;74(5):1755-1762.
Aubrey C, Nelson G. Enhanced Recovery after Surgery (ERAS) for minimally invasive gynecologic oncology surgery: a review. Current Oncology. 2023;30(10):9357-9366.
La Verde M, Riemma G, Tropea A, Biondi A, Cianci S. Ultra-minimally invasive surgery in gynecological patients: a review of the literature. Updates in Surgery. 2022;74(3):843-855.
Bakshi SG, Gupta S, Jain P. Postoperative pain management following minimally invasive abdominal cancer surgeries - an audit. Indian Journal of Cancer. 2024;61(2):368-374.
Della Corte L, Mercorio A, Palumbo M, Viciglione F, Cafasso V, Candice A, et al. Minimally invasive anesthesia for laparoscopic hysterectomy: a case series. Archives of Gynecology and Obstetrics. 2022;306(6):2001-2007.
Vazquez EFO, Victoria JCL, López GAC, Tapia ECH, Acosta FIM, Namcela SDRP. Minimally invasive gynecologic surgery and enhanced recovery and outcomes: a literature review. Cureus. 2025;17(5).
Elsaeed UA, Algyoushy EAFIH, Hatem DLM. Effect of port-site and intraperitoneal local anesthetic injection versus placebo on postoperative pain and recovery after gynecologic laparoscopic surgery: a randomized controlled trial. Scientific Reports. 2025;15(1):32466.
Ostby SA, Narasimhulu D, Kinney MAO, Cliby W, Langstraat C, Bakkum-Gamez JN, et al. Defining optimal perioperative analgesia in patients undergoing laparotomy for advanced gynecologic malignancy: a randomized controlled trial. Gynecologic Oncology. 2024;190:11-17.
Tochie JN, Bengono Bengono RS, Metogo JM, Ndikontar R, Ngouatna S, Ntock FN, et al. The efficacy and safety of an adapted opioid-free anesthesia regimen versus conventional general anesthesia in gynecological surgery for low-resource settings: a randomized pilot study. BMC Anesthesiology. 2022;22(1):325.
Huang L, Cai Y, Yang L, Liu L, Wang Q, Shi K. Ultrasound-guided anterior quadratus lumborum block at the L2 level for postsurgical analgesia in patients undergoing laparoscopic gynaecological surgery: a single-centre, randomised, double-blinded trial at a university-affiliated hospital in China. BMJ Open. 2023;13(10):e073917.
Luo H, Yang Y, He Z, Pan C, Wu X, Cao S, et al. Esketamine as an epidural adjuvant for postoperative analgesia in gynecological malignancy surgery: a randomized trial. Journal of Pain Research. 2025:4349-4359.
Wang W, Tang Y, Meng Y, Zhou D, Wang J, Li N. Comparative analysis of postoperative recovery and analgesia in gynecologic laparoscopic surgery with total intravenous anesthesia versus combined intravenous inhalational anesthesia, both with ultrasound-guided transversus abdominis plane block: a randomized controlled trial. Journal of Investigative Surgery. 2025;38(1):2594554.
Malik R, Verma R. Does local infiltration of anesthesia reduce port-site pain in gynecological laparoscopic surgeries? A pilot study. Gynecology and Minimally Invasive Therapy. 2024;13(2):101-104.
Choi EK, Baek J, Lee D, Kim DY. Effect of music therapy on quality of recovery and postoperative pain after gynecological laparoscopy. Medicine. 2023;102(9):e33071.
Payne O, Smith V, Rolnik DL, Davies-Tuck M, Warty R, Seo D, et al. Virtual reality and its use in post-operative pain following laparoscopy: a feasibility study. Scientific Reports. 2022;12(1):13137.
Restaino S, Paparcura F, Arcieri M, Poli A, Pellecchia G, Bogani G, et al. Postoperative pain after MiniLap percutaneous versus standard laparoscopic salpingo-oophorectomy: a propensity-matched study. International Journal of Gynecology & Obstetrics. 2025;170(2):857-864.
Manici M, Kalyoncu İ, Vatansever D, Gürkan Y. The analgesic benefit of rectus sheath block in robotic gynecologic surgery: a retrospective study. Medicine. 2024;103(43):e40176.
Fuica R, Krochek C, Weissbrod R, Greenman D, Freundlich A, Gozal Y. Reduced postoperative pain in patients receiving nociception monitor guided analgesia during elective major abdominal surgery: a randomized, controlled trial. Journal of Clinical Monitoring and Computing. 2023;37(2):481-491.
Atsumi C, Aikawa K, Takahashi K, Okada K, Morimoto Y. The comparison of postoperative analgesic requirements between modified thoracoabdominal nerve block through perichondrial approach versus wound infiltration analgesia in patients undergoing gynecological laparoscopic surgery: a retrospective, exploratory study. JA Clinical Reports. 2023;9(1):39.
Akyol D, Özcan FG. Comparison of the effectiveness of subcostal transversus abdominis plane and rectus sheath blocks in postoperative analgesia in major open gynecological cancer surgeries: a prospective randomized study. Anesthesia and Pain Medicine. 2024;19(4):353-361.
Otake A, Sasamoto N, Sato N, Kumasaka R, Yamamoto Y, Adachi K. Comparative study of postoperative analgesic effects of intraoperative levobupivacaine local infiltration anesthesia and transversus abdominis plane block following gynecologic laparoscopy. Gynecology and Minimally Invasive Therapy. 2022;11(4):231-237.
