{"id":3113,"date":"2021-05-19T13:16:44","date_gmt":"2021-05-19T10:16:44","guid":{"rendered":"https:\/\/www.esrahellas.gr\/?page_id=3113"},"modified":"2021-07-14T18:45:00","modified_gmt":"2021-07-14T15:45:00","slug":"abdominal-hysterectomy","status":"publish","type":"page","link":"https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/abdominal-hysterectomy\/","title":{"rendered":"Abdominal Hysterectomy"},"content":{"rendered":"  <div id=\"page-header-2063913453\" class=\"page-header-wrapper\">\n  <div class=\"page-title dark featured-title\">\n\n    \n    <div class=\"page-title-inner container align-center flex-row medium-flex-wrap\" >\n              <div class=\"title-wrapper flex-col text-left medium-text-center\">\n          <h1 class=\"entry-title mb-0\">\n            Abdominal Hysterectomy          <\/h1>\n        <\/div>\n                    <div class=\"title-content flex-col flex-right text-right medium-text-center\">\n        <div class=\"title-share pt-half pb-half\"><div class=\"social-icons share-icons share-row relative icon-style-fill\" ><a href=\"https:\/\/www.facebook.com\/sharer.php?u=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/abdominal-hysterectomy\/\" data-label=\"Facebook\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip facebook\" title=\"Share on Facebook\" aria-label=\"Share on Facebook\" rel=\"noopener nofollow\"><i class=\"icon-facebook\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/twitter.com\/share?url=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/abdominal-hysterectomy\/\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip twitter\" title=\"Share on Twitter\" aria-label=\"Share on Twitter\" rel=\"noopener nofollow\"><i class=\"icon-twitter\" aria-hidden=\"true\"><\/i><\/a><a href=\"mailto:?subject=Abdominal%20Hysterectomy&body=Check%20this%20out%3A%20https%3A%2F%2Fwww.esrahellas.gr%2Fen%2Fprospect-recommendations%2Fabdominal-hysterectomy%2F\" class=\"icon primary button circle tooltip email\" title=\"Email to a Friend\" aria-label=\"Email to a Friend\" rel=\"nofollow\"><i class=\"icon-envelop\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/www.linkedin.com\/shareArticle?mini=true&url=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/abdominal-hysterectomy\/&title=Abdominal%20Hysterectomy\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip linkedin\" title=\"Share on LinkedIn\" aria-label=\"Share on LinkedIn\" rel=\"noopener nofollow\"><i class=\"icon-linkedin\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div>      <\/div>\n    <\/div>\n\n     \n<style>\n#page-header-2063913453 {\n  margin-bottom: 20px;\n}\n<\/style>\n  <\/div>\n    <\/div>\n  \n<div class=\"row align-middle\"  id=\"row-1484718144\">\n\n\t<div id=\"col-1056232123\" class=\"col medium-4 small-12 large-4\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\t<div class=\"img has-hover x md-x lg-x y md-y lg-y\" id=\"image_1332409505\">\n\t\t\t\t\t\t\t\t<div class=\"img-inner dark\" >\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"66\" src=\"https:\/\/www.esrahellas.gr\/wp-content\/uploads\/2021\/05\/LOGO-PROSPECT-1.jpg\" class=\"attachment-large size-large\" alt=\"\" \/>\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\n<style>\n#image_1332409505 {\n  width: 100%;\n}\n<\/style>\n\t<\/div>\n\t\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-2039769207\" class=\"col medium-8 small-12 large-8\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<h3>Abdominal Hysterectomy <\/h3>\n<p>GUIDELINES &#8211; RECOMMENDATIONS<br \/>Procedure Specific Postoperative Pain Management<\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n<div class=\"row\"  id=\"row-1961859588\">\n\n\t<div id=\"col-494431797\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>GUIDELINES &#8211; RECOMMENDATIONS<\/strong><\/p>\n<p><strong>Procedure Specific Postoperative Pain Management<\/strong><\/p>\n<p><a href=\"http:\/\/www.postoppain.org\/\">www.postoppain.org<\/a><\/p>\n<p><strong>ABDOMINAL HYSTERECTOMY<\/strong><\/p>\n<p><strong>SUMMARY RECOMMENDATIONS<\/strong><\/p>\n<p>Algorithm for the Management of Postoperative Pain:\u00a0<a href=\"http:\/\/www.postoppain.org\/image.aspx?imgid=19\">click here<\/a><\/p>\n<p>Patient Advice:\u00a0<a href=\"http:\/\/www.postoppain.org\/content.aspx?nid=68596\">click here<\/a><\/p>\n<p>Patient Assessment:\u00a0<a href=\"http:\/\/www.postoppain.org\/content.aspx?nid=68598\">click here<\/a><\/p>\n<p>The recommendations of the\u00a0<strong>PROSPECT Working Group<\/strong>\u00a0are graded A \u2013 D, based on the level of evidence from the studies, which is in accordance with the Oxford Centre for Evidence &#8211; Based Medicine (<a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=9\">CEBM website accessed Dec 2003, Sackett 2000<\/a>).\u00a0In the context of\u00a0<strong>PROSPECT,<\/strong>\u00a0recommendations based on procedure &#8211; specific evidence are grade A (randomized clinical trials), those based on transferable evidence are grade B (randomized clinical trials) or grade C (retrospective studies or case series) and those based on clinical practice are grade D (<a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=10\">Click here for further information on levels of evidence and grades of recommendation<\/a>).<\/p>\n<p><strong>PROSPECT<\/strong>\u00a0provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgments based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted. The following pre-, intra- and postoperative interventions have been evaluated for the management of postoperative pain following abdominal hysterectomy.<\/p>\n<p><strong>PREOPERATIVE<\/strong><\/p>\n<p><strong>Recommended<\/strong><\/p>\n<ul>\n<li>\n<p>Single-dose spinal local anaesthetic plus strong opioid, for anaesthetic (grade D) and postoperative analgesic purposes (grade A), but the benefits must be weighed against the risks of the invasive nature of the procedure<\/p>\n<\/li>\n<li>\n<p>Cognitive intervention (grade A)<\/p>\n<\/li>\n<\/ul>\n<p><strong>Not recommended<\/strong><\/p>\n<ul type=\"disc\">\n<li>\n<p>Systemic analgesics (e.g. IV COX-2 inhibitors, conventional NSAIDs, strong opioids), except to secure sufficient analgesia when the patient wakes up (e.g. oral COX-2 inhibitors) (grade A)<\/p>\n<\/li>\n<li>\n<p>Clonidine, NMDA-receptor antagonists and benzodiazepines (grade A)<\/p>\n<\/li>\n<li>\n<p>Epidural single dose for postoperative analgesia (grade A)<\/p>\n<\/li>\n<li>\n<p>Local anaesthetic skin infiltration at the proposed site of incision (grade A) (but intra-operative wound infiltration is recommended, see below)<\/p>\n<\/li>\n<li>\n<p>Homeopathic arnica and self-relaxation techniques (grade A)<\/p>\n<\/li>\n<\/ul>\n<p><strong>INTRAOPERATIVE<\/strong><\/p>\n<p><strong>Recommended<\/strong><\/p>\n<ul type=\"disc\">\n<li>\n<p>General anaesthesia, or single dose spinal anaesthesia with or without light general anaesthesia in low-risk patients\u00a0(grade D)<\/p>\n<\/li>\n<li>\n<p>Epidural anaesthesia combined with light general anaesthesia or combined spinal-epidural anaesthesia, in high-risk patients (grade A)<\/p>\n<\/li>\n<li>\n<p>Strong opioids administered in enough time to secure sufficient analgesia when the patient wakes (grade A)<\/p>\n<\/li>\n<li>\n<p>Wound infiltration before closure (grade A)<\/p>\n<\/li>\n<li>\n<p>LAVH or VH rather than abdominal hysterectomy, only if allowed by the surgical requirements (based on technical feasibility, patient indication for hysterectomy and risk factors) (grade A)<\/p>\n<\/li>\n<li>\n<p>Pfannenstiel incision, only if allowed by the surgical requirements (based on technical feasibility, patient indication for hysterectomy and risk factors) (grade B)<\/p>\n<\/li>\n<li>\n<p>Diathermy incision (grade B)<\/p>\n<\/li>\n<li>\n<p>Active patient warming in high-risk patients (grade A)<\/p>\n<\/li>\n<li>\n<p>Intra-operative music (grade A)<\/p>\n<\/li>\n<\/ul>\n<p><strong>Not recommended<\/strong><\/p>\n<ul type=\"disc\">\n<li>\n<p>Epidural single dose for postoperative analgesia (grade A)<\/p>\n<\/li>\n<li>\n<p>Adenosine, NMDA-receptor antagonists, benzodiazepines or tryptophan (all grade A)<\/p>\n<\/li>\n<li>\n<p>Intraperitoneal analgesia (grade A)<\/p>\n<\/li>\n<li>\n<p>Unsutured peritoneum, wet film dressing (both grade A) or surgical drains (grade D)<\/p>\n<\/li>\n<li>\n<p>Therapeutic suggestions or electroacupuncture (both grade A)<\/p>\n<\/li>\n<\/ul>\n<p><strong>POSTOPERATIVE<\/strong><\/p>\n<p><strong>Recommended<\/strong><\/p>\n<ul type=\"disc\">\n<li>\n<p>COX-2 selective inhibitors or conventional NSAIDs, in combination with strong opioids for high-intensity pain (VAS\u00b350 mm) or with weak opioids for moderate- (VAS&lt;50&gt;30) or low-intensity pain (VAS\u00a330 mm) (grade A)<\/p>\n<\/li>\n<li>\n<p>Strong opioids by IV PCA or by fixed IV dosing titrated to pain intensity (grade A)<\/p>\n<\/li>\n<li>\n<p>Paracetamol for moderate- (VAS&gt;30&lt;50) or low-intensity (VAS\u00a330 mm) pain, in combination with COX-2 inhibitors or conventional NSAIDs (grade A)<\/p>\n<\/li>\n<li>\n<p>Epidural analgesia in high-risk patients (grade A and D)<\/p>\n<\/li>\n<\/ul>\n<p><strong>Not recommended<\/strong><\/p>\n<ul type=\"disc\">\n<li>\n<p>Epidural analgesia for routine use in low-risk patients (grade D)<\/p>\n<\/li>\n<li>\n<p>Repeat spinal boluses of analgesic (grade D)<\/p>\n<\/li>\n<li>\n<p>Concomitant administration of COX-2 selective inhibitors or conventional NSAIDs with epidural analgesia (grade B)<\/p>\n<\/li>\n<li>\n<p>Continuous infusion of strong opioid during PCA bolus dosing (grade D)<\/p>\n<\/li>\n<li>\n<p>IM administration of strong opioids (grade D)<\/p>\n<\/li>\n<li>\n<p>Intra-nasal, slow-release oral and transdermal patch administration of strong opioids (grade D)<\/p>\n<\/li>\n<li>\n<p>Paracetamol for high-intensity pain (VAS\u00b350 mm) (grade B)<\/p>\n<\/li>\n<li>\n<p>NMDA-receptor antagonists and benzodiazepines (both grade A)<\/p>\n<\/li>\n<li>\n<p>Clonidine, pentazocine, clomipramine, delta-9-tetrahydrocannabinol and naloxone (all grade A)<\/p>\n<\/li>\n<li>\n<p>Continuous wound infiltration of local anaesthetics after closure (grade A) (although pre-closure wound infiltration is recommended, see above)<\/p>\n<\/li>\n<li>\n<p>Music in PACU, homeopathic arnica or self-relaxation techniques (all grade A)<\/p>\n<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n\t<div id=\"gap-2056931296\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-2056931296 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n<div class=\"social-icons share-icons share-row relative full-width text-center\" ><a href=\"https:\/\/www.facebook.com\/sharer.php?u=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/abdominal-hysterectomy\/\" data-label=\"Facebook\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip facebook\" title=\"Share on Facebook\" aria-label=\"Share on Facebook\" rel=\"noopener nofollow\"><i class=\"icon-facebook\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/twitter.com\/share?url=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/abdominal-hysterectomy\/\" 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