An Overview of Hysterectomy

Angie L. Goeser, PharmD; Matthew J. Hasiak, PharmD; Jared L. Hochstettler, PharmD Candidate

Disclosures

US Pharmacist. 2008;33(9):HS11-HS20. 

In This Article

Pharmacologic Therapy

To prevent the onset of infection, it is recommended that patients undergoing hysterectomy be treated prophylactically with a broad-spectrum antibiotic 30 minutes prior to surgery.[35] In addition, patients at risk for developing deep venous thrombosis or pulmonary embolism may be given heparin or enoxaparin before the procedure to prevent the occurrence of these events.[22,23,28] Various medications used preoperatively and intraoperatively, and their doses, are detailed in Table 2 .[18,23,28,36]

With up to 85% of patients experiencing moderate-to-severe pain after hysterectomy, postoperative pain management is essential.[37] Successful pain control leads to increased patient satisfaction, shorter recovery time, and decreased overall health care costs for the procedure.[37,38] In the most severe cases, IV or intramuscular injections of an opiate such as morphine, fentanyl, or hydromorphone should be utilized; however, oral analgesic agents are likely to be adequate on the first postoperative day.[23] Acetaminophen and nonsteroidal anti-inflammatory drugs are two nonopioid treatment options to be considered. Because they are well tolerated, are nonaddictive, and carry a more desirable side-effect profile than opiates, these agents should be used when appropriate for the management of postoperative inpatient and outpatient pain.[39]

Hysterectomy patients may experience the early onset of menopausal symptoms, including hot flashes, night sweats, vaginal dryness, anxiety, irritability, depression, and loss of libido.[40] For relief, the North American Menopause Society first recommends lifestyle and behavioral changes, such as lowering the body's core temperature (e.g., meditation, caloric restriction), regular exercise, practicing relaxation techniques, and avoiding hot-flash triggers (i.e., spicy food, caffeine, alcohol). If these lifestyle changes do not control the symptoms, hormonal (estrogen replacement therapy) or nonhormonal drug therapy may be used.[40]

Estrogen replacement is the most effective therapy for the treatment of moderate-to-severe vasomotor symptoms associated with menopause, reducing hot flashes from 50% to 100% within the first four weeks of medication initiation.[41] While there are no current guide- lines as to the duration of estrogen therapy, the FDA recommends the lowest dose for the least amount of time, with continual physician follow-up to evaluate effectiveness. Estrogen-containing products available for use in the treatment of menopausal symptoms are listed in Table 3 .[36]

Although no nonhormonal treatments for menopausal symptoms are approved by the FDA, several agents are often used off-label to treat the vasomotor symptoms associated with menopause. They include the following: selective serotonin reuptake inhibitors, venlafaxine, clonidine, gabapentin, vitamin E, isoflavones, and black cohosh.[42]

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