Effects of Follicular versus Luteal Phase on Postoperative Mechanical Hyperalgesia Following Laparoscopic Myomectomy: A Prospective Observational Study

Bo Long,1,2,* Huijun Yang,3,* Zhirong Yan,1 Lijun Yang11Department of Anesthesiology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, People’s Republic of China; 2Department of Anesthesiology, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350001, People’s Republic of China; 3Department of Gynecology, The First Hospital of Putian City, Putian, 351100, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lijun Yang, Department of Anesthesiology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, People’s Republic of China, Email [email protected]: Previous studies have suggested that pain sensitivity may be lower during the follicular phase than during the luteal phase, and similar findings have been observed following gynecologic laparoscopic surgery. However, the effect of the menstrual cycle phase on postoperative mechanical hyperalgesia following laparoscopic myomectomy and its potential value for guiding the timing of surgery remain unclear.Purpose: This study aimed to compare postoperative mechanical hyperalgesia in women undergoing laparoscopic myomectomy during the follicular versus the luteal phase.Patients and Methods: Eighty patients scheduled for elective laparoscopic myomectomy were enrolled. Forearm pressure pain thresholds (FPPT) and incisional pressure pain thresholds (IPPT) were measured preoperatively and at 1 h, 24 h, and 48 h postoperatively. Postoperative pain was assessed using the Numeric Rating Scale (NRS) within 48 h after surgery. Total sufentanil consumption and the number of patients requiring rescue analgesia were also recorded.Results: FPPT showed a significant group main effect (P = 0.04), with higher FPPT in the follicular group than in the luteal group (mean difference 0.18, 95% CI 0.03– 0.73). The group × time interaction and IPPT comparison were not significant (P > 0.05). For NRS, the group × time interaction was significant (P = 0.046). After Benjamini–Hochberg correction, NRS at 24 h was higher in the luteal group (mean difference 0.43, 95% CI 0.13– 0.72, P = 0.03), with no differences at other time points. More luteal-phase patients required rescue analgesia within 24 h, although total sufentanil consumption did not differ.Conclusion: The luteal phase was associated with a lower overall forearm pressure pain threshold and a higher rescue analgesia rate after laparoscopic myomectomy, suggesting that the phase of the menstrual cycle may be associated with postoperative pain sensitivity and analgesic requirements.Keywords: hyperalgesia, luteal phase, follicular phase, laparoscopic myomectomy