Dynamic observation on pain of Trocar puncture hole in abdominal wall after gynecologic laparoscopic surgery in rapid rehabilitation surgery practice

Hou Kun; Guo Jun; Yu Fei

doi:10.3760/j.issn.1673-4777.2025.07.018

Abstract：Objective To observe the dynamic changes of abdominal Trocar puncture hole pain after gynecologic laparoscopic surgery in the practice of rapid rehabilitation surgery.Methods A total of 40 patients with laparoscopic surgery who received patient-controlled intravenous analgesia after fast track surgery in Beijing Tongren Hospital,Capital Medical University from October 2019 to March 2020 were selected.The visual analogue scale(VAS)score was used to evaluate the postoperative pain changes of different Trocar puncture holes in the abdominal wall at 2,4,8,12 and 24 h after surgery,and the incidence of postoperative analgesia related compli-cations and the use of rescue analgesic drugs were recorded.Results The age of 40 patients was(35±9)years.At 2,4,8,12,24 h after surgery,the VAS scores of the puncture hole with a median diameter of 1.0 cm under the umbilicus and the puncture hole with a diameter of 1.5 cm on the left side of the umbilicus were higher than those of the puncture hole with a diameter of 0.5 cm on the left side of the umbilicus and 0.5 cm on the right side of the umbilicus(all P＜0.05).The VAS scores of Trocar puncture hole with a median diameter of 1.0 cm under the umbilicus were significantly different at 2,4,8,12 and 24 h after operation(P＜0.001),which mainly showed that the VAS score gradually increased from 2 h to 8 h after operation,and then decreased.The VAS scores of the Trocar puncture hole with a diameter of 1.5 cm on the left side of the umbilicus were significantly different at 2,4,8,12,24 h after operation(P＜0.001),which mainly showed that the VAS score increased significantly at 4 h after operation,peaked at 8 h and continued to 12 h,and then decreased.The postoperative Self-Rating Anxiety Scale score was significantly lower than that before surgery[37.0(33.5,44.8)scores vs 40.0(36.3,51.5)scores](Z=-4.103,P=0.002).A total of 18 patients(45.0％)developed nausea and vomiting,and 35 patients(87.5％)developed lethargy.Rescue analgesia was used in 9 patients(22.5％).Conclusion In the practice of fast track surgery,the abdominal wall pain after gynecologic laparoscopic surgery is mainly concentrated in the Trocar puncture hole with a diameter of 1.0 cm below the middle of the umbilicus and 1.5 cm on the left of the umbilicus,and the pain caused by the puncture hole is mainly 4-12 h after surgery,reaching a peak at 8 h after surgery.