Comparison of postoperative pain outcomes after vertical or Pfannenstiel incision for major gynecologic surgery

ABSTRACT Objective: The Pfannenstiel incision is commonly used for gynecologic surgery. It is not known if this incision is associated with less postoperative pain compared to a vertical midline incision. Therefore, as part of a study to evaluate the postoperative analgesic effects and dose response of intravenous adenosine in patients undergoing open abdominal gynecologic surgery, this manuscript compares postoperative pain and analgesic consumption in patients who had a midline vertical incision or a Pfannenstiel incision. Research design and methods: This is a secondary analysis of data from a primary study investigating the dose response of IV adenosine for postoperative analgesia. Women scheduled for elective major gynecologic surgery under general anesthesia were enrolled and randomly assigned to receive one of four doses of intraoperative adenosine infusion (25, 50, 100, or 200 µg/kg/min) or matching placebo (normal saline). The anesthetic technique was standardized and adjusted based on hemodynamic and depth of anesthesia (bispectral index) values. Postoperative analgesia was provided with a standardized morphine patient controlled analgesia protocol which included rescue ketorolac, as needed. Comparative outcome analysis of the midline and Pfannenstiel skin incisions with regards to analgesic consumption and pain scores was performed and presented in this manuscript. Results: A total of 165 patients were identified; 105 women had a Pfannenstiel incision and 60 had the lower midline abdominal incision. There were no differences between the midline and Pfannenstiel groups with respect to intraoperative fentanyl, postoperative pain scores [worst pain scores 0-24 h (mean ± SD) 8.2 ± 2.1 vs. 8.2 ± 1.9), p = 0.352], cumulative opioid consumption [0-24 h morphine equivalents (mean ± SD) 63 ± 27 vs. 72 ± 43 mg, p = 0.496], or need for rescue ketorolac. While the duration of surgery was longer in patients who had a vertical incision (p = 0.02), there was no difference between the groups in the duration of postanesthesia care unit (44 ± 53 vs. 30 ± 45 min, p = 0.093) or hospital stays (74 ± 27 vs. 67 ± 20 h, p = 0.254). Conclusions: There was no significant difference in postoperative pain and opioid consumption in patients undergoing major abdominal gynecologic surgery performed with either a midline or Pfannenstiel incision. However, it is important to note that since this a secondary analysis of data from a primary study investigating the dose response o