Impact of Intraperitoneal Drain Placement on Postoperative Pain After Total Laparoscopic Hysterectomy

Introduction: Total laparoscopic hysterectomy (TLH) is widely performed for benign gynecologic conditions; however, postoperative pain particularly shoulder pain related to residual intraperitoneal CO2 remains a clinical concern. This study aimed to evaluate whether drain placement reduces postoperative pain and analgesic requirements after benign TLH. Methods: In this prospective observational study, 129 women undergoing TLH were included; 86 received an intraperitoneal drain and 43 did not. Drain placement was based on the surgeon’s intraoperative judgment. To ensure a homogeneous low-complexity cohort, cases with complications or deviations from standard TLH were excluded. Postoperative shoulder, chest, and abdominal pain were assessed using a 10-point visual analog scale at 6, 12, and 24 hours. Analgesic use and early postoperative outcomes were also recorded. Results: Baseline demographic and perioperative characteristics were comparable between groups. Multivariable regression analysis showed that drain placement was independently associated with higher shoulder pain at 6 and 12 hours (p = 0.015 and p < 0.001) and higher chest pain at 6 hours (p = 0.039). Abdominal pain was higher at 6 hours but lower at 24 hours in the drain group (p = 0.039 and p = 0.032). Despite these time-dependent differences, overall postoperative analgesic consumption during the first 2 days was significantly higher in patients with drains (p < 0.05). Conclusion: Intraperitoneal drain placement after benign TLH was associated with increased early postoperative pain and did not reduce overall analgesic consumption. Routine drain use cannot be recommended, and selective placement should be reserved for specific clinical situations. © 2026 by SLS, Society of Laparoscopic & Robotic Surgeons.