Pain syndrome after laparoscopic myomectomy: pathogenesis and evolution of methods for combating pain

DOI

https://dx.doi.org/10.18565/aig.2025.205

Kharlov N.S., Shapovalova E.A., Basos A.S., Belousov A.M.
Saint Petersburg State University Hospital, St. Petersburg, Russia

Laparoscopic myomectomy is the main surgical option in the treatment of uterine fibroids and it currently has become the gold standard in the uterus-sparing approach. Despite its minimally invasive nature and proven clinical efficacy, postoperative pain remains a significant concern. According to published data, up to 80% of patients report moderate to severe pain during the first 24 hours after surgery. This can affect the early postoperative period, delay mobilization, prolong hospitalization, and increase the need for systemic analgesics, including opioids. Persistent pain may also reduce patient’s satisfaction with the treatment and limit the implementation of Enhanced Recovery After Surgery (ERAS) protocols aimed at improving perioperative outcomes.
This review provides a comprehensive analysis of the pathophysiological mechanisms underlying postoperative pain after laparoscopic myomectomy. It discusses the activation of somatic and visceral nociceptors, the development of peripheral and central sensitization, and the role of intracellular signaling and inflammatory mediators. Particular attention is given to the anatomical and physiological characteristics of uterine innervation, including the zones of overlapping somatic and visceral nociceptive input, and the superior hypogastric plexus in pain transmission. The characteristics of visceral pain, a challenging and less manageable aspect of postoperative pain, are discussed.
The analysis of published materials provides up-to-date information on modern approaches to pain management in patients after laparoscopic myomectomy. Special focus is placed on multimodal and preemptive analgesia techniques aimed at reducing both pain intensity and opioid consumption. Local interventions such as anterior abdominal wall infiltration and superior hypogastric plexus block are discussed as part of a pathophysiology-based approach to postoperative pain control. Data on the effect of pain severity on recovery parameters, patient satisfaction, and overall quality of medical care are presented.
Conclusion: The findings support the need for personalized analgesic strategies that account for neurophysiological pain mechanisms and surgical specifics. The use of pathogenetically-based and preemptive analgesic strategies can not only reduce the severity of pain, but can also improve the overall course of the postoperative period, increase patient compliance and the effectiveness of ERAS protocols.

Authors’ contributions: Kharlov N.S., Shapovalova E.A., Basos A.S. – developing the concept of the study; Kharlov N.S. – collecting and processing the material; Kharlov N.S., Shapovalova E.A. – writing the text; Shapovalova E.A., Basos A.S., Belousov A.M. – editing the article.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Kharlov N.S., Shapovalova E.A., Basos A.S., Belousov A.M.
Pain syndrome after laparoscopic myomectomy:
pathogenesis and evolution of methods for combating pain.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (10): 12-19 (in Russian)
https://dx.doi.org/10.18565/aig.2025.205

analgesia

hypogastric plexus

laparoscopic myomectomy

multimodal analgesia

postoperative pain

preemptive analgesia

central sensitization

visceral pain

Full text (in Russian)

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Received 30.07.2025

Accepted 22.09.2025

Nikita S. Kharlov, obstetrician-gynecologist, oncologist, Head of the Department of Gynecology, Saint Petersburg State University Hospital,
190020, Russia, St. Petersburg, Fontanka River Embankment, 154, +7(926)283-93-77, nikita.kharlov@gmail.com, https://orcid.org/0000-0002-8318-5201
Ekaterina A. Shapovalova, PhD, obstetrician-gynecologist, Head of the Department of Outpatient Gynecology, Saint Petersburg State University Hospital,
190020, Russia, St. Petersburg, Fontanka River Embankment, 154, +7(911)902-12-64, katerina_andmed@mail.ru, https://orcid.org/0000-0002-4574-2492
Alexander S. Basos, PhD, obstetrician-gynecologist, Head of Operative Gynecology Program, Saint Petersburg State University Hospital,
190020, Russia, St. Petersburg, Fontanka River Embankment, 154, +7(904)511-88-44, asbasos@gmail.com, https://orcid.org/0000-0001-5020-9759
Alexander M. Belousov, Dr. Med. Sci., surgeon, oncologist, Deputy Chief Physician for Surgery and Oncology, Saint Petersburg State University Hospital,
190020, Russia, St. Petersburg, Fontanka River Embankment, 154, +7(926)304-83-12, info@aleksandrbelousov.ru, https://orcid.org/0000-0002-2274-8170
Corresponding author: Nikita S. Kharlov, nikita.kharlov@gmail.com

Pain syndrome after laparoscopic myomectomy: pathogenesis and evolution of methods for combating pain

Kharlov N.S., Shapovalova E.A., Basos A.S., Belousov A.M.

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