Article title age-related differences in postoperative pain after single-port access adnexal laparoscopy: a three-arm analgesic strategy comparison

Background: This study evaluated age-related differences in postoperative pain and analgesic requirements after single-port access (SPA) laparoscopy for adnexal disease under three analgesic regimens.

This retrospective cohort study included 470 patients stratified into: 55 years (n = 75). Patients received continuous wound infiltration (CWI) alone, intravenous patient-controlled analgesia (IV PCA) alone, or combined CWI + IV PCA. NRS pain scores at 6, 12, 24, and 48 h were the primary outcomes. Multivariable regression adjusted for analgesic regimen, surgery type, and body mass index, with additional adjustment for endometriosis in sensitivity analysis.

Unadjusted NRS scores did not differ among age groups. Rescue nonsteroidal anti-inflammatory drug use was higher in patients aged <40 years at 0–6, 6–12, and 24–48 h. After adjustment, patients aged <40 years had significantly higher NRS scores at 24 h (β = 0.276, p = 0.046). Combined CWI and IV PCA was associated with the lowest postoperative pain scores across age groups; however, a formal age × treatment interaction was not statistically significant. Sensitivity analysis yielded consistent findings.

Younger age (<40 years) was independently associated with modestly higher postoperative pain at 24 h after SPA adnexal laparoscopy, although this difference was below the minimal clinically important difference. These findings may inform individualized analgesic planning, pending confirmation in prospective studies. 1 Introduction Single-port access (SPA) laparoscopy has become increasingly adopted in gynecologic surgery for adnexal disease due to its cosmetic advantage and comparable surgical outcomes to conventional multi-port laparoscopy (, ). Despite its minimally invasive nature, postoperative pain at the umbilical site remains clinically significant, as all instruments must be inserted simultaneously through a single opening, requiring a substantially larger incision than conventional laparoscopy (). Among analgesic strategies, intravenous patient-controlled analgesia (IV PCA) with opioids and continuous wound infiltration (CWI) with local anesthetics have each demonstrated efficacy after laparoscopic procedures (, ). Our group has previously reported that combined CWI + IV PCA significantly reduced postoperative pain and postoperative nausea and vomiting (PONV) compared with IV PCA alone, and that CWI alone produced comparable pain reduction except during the acute phase (within 6 h) (, ). Age is widely recognized as a modulator of pain perception and analgesic requirements, with older patients generally reporting lower postoperative pain scores (). In female patients, declining estrogen levels through the menopausal transition may modulate pain sensitivity and opioid requirements (, ). However, studies on age and postoperative pain have predominantly included mixed-sex populations undergoing diverse surgical procedures (), and whether age modifies the relative effectiveness of specific analgesic strategies — particularly in a multimodal context within an enhanced recovery framework (, ) — remains unexplored in exclusively female gynecologic laparoscopic cohorts. The present study therefore aimed to: (1) compare postoperative numeric rating scale (NRS) pain scores and rescue analgesic use across three age groups (55 years); (2) evaluate the relative effectiveness of each analgesic regimen within each age group; and (3) identify independent predictors of postoperative pain outcomes using multivariable regression, with a sensitivity analysis additionally adjusting for endometriosis. 2 Materials and methods 2.1 Study design and patient population This retrospective cohort study was conducted at Kangbuk Samsung Hospital (KBSMC) and Uijeongbu Eulji Medical Center (UEMC), South Korea, between January 2020 and September 2023. Institutional review board approval was obtained from both institutions (KBSMC: 2022-12-030; UEMC: 2023-02-015), and the requirement for informed consent was waived. This study is a secondary analysis of an existing two-institution cohort of patients who underwent SPA adnexal laparoscopy. The same 470-patient cohort was previously analyzed to compare the analgesic and side-effect profiles of CWI, IV PCA, and their combination (), whereas the present analysis addresses a distinct question—age-related differences in postoperative pain and analgesic requirement. Eligible patients were: (1) female patients aged ≥18 years; (2) those who underwent SPA laparoscopic surgery for adnexal disease; (3) those who received standardized postoperative analgesia; and (4) those with complete NRS scores at all four postoperative time points (6, 12, 24, and 48 h). Patients were excluded if they: (1) required conversion to multi-port or open surgery; (2) underwent concurrent gynecologic procedures; or (3) had premature discontinuation of IV PCA. The observed differences in surgery type and pathological diagnosis across age groups reflect the natural clinical distribution of adnexal disease by age, wherein younger patients predominantly present with cystic ovarian lesions requiring cystectomy, while older postmenopausal patients more commonly undergo adnexectomy for benign adnexal masses. Premature IV PCA discontinuation was predominantly due to opioid-related systemic side effects (mainly postoperative nausea and/or vomiting, with a smaller number due to dizziness and hypotension) rather than inadequate analgesia; the number and reasons for exclusion at each stage are shown in the patient-selection flow diagram (Figure 1). Figure 1 2.2 Age group classification Patients were stratified into three age groups according to STRAW+10 criteria () and Korean menopause epidemiology (): reproductive (55 years). 2.3 Analgesic regimens (1) CWI alone: A CWI system (ON-Q Pain Buster®) delivering 0.3% ropivacaine at 2 mL/h for 48 h. (2) IV PCA alone: Fentanyl citrate (900–1800µg, adjusted for age and body weight) was diluted in 100 mL of 0.9% normal saline and infused continuously at a basal rate of 1 mL/h (equivalent to 9–18 µg/h depending on the total dose), with a patient-triggered bolus of 15 µg fentanyl citrate and a 15-min lockout interval. Per-patient actual fentanyl consumption was not available in this retrospective dataset. (3) CWI + IV PCA: Combined use of both modalities. Rescue nonsteroidal anti-inflammatory drugs (NSAIDs) were administered upon on patient request (NRS ≥4), and pethidine was used as a second-line agent. 2.4 Outcome measures The primary outcome was the NRS pain score (0–10) at 6, 12, 24, and 48 h postoperatively. Secondary outcomes included rescue NSAIDs use, pethidine use, PONV, and length of hospital stay. PONV was ascertained directly from the symptom section of the routine nursing records (documented patient-reported nausea and vomiting). At both institutions, routine pharmacologic PONV prophylaxis is not part of the standard protocol for benign gynecologic laparoscopic surgery; antiemetics were given as rescue treatment when symptoms occurred. NRS scores were assessed at rest, at the bedside, by the ward nursing staff as part of routine scheduled pain assessment, and were generally recorded before administration of any rescue analgesic. Because pain was documented as part of routine time-based nursing records, the scheduled assessment points were used. 2.5 Statistical analysis Unadjusted comparisons were performed using the Kruskal–Wallis test for continuous variables and the chi-square or Fisher's exact test for categorical variables. Post hoc pairwise comparisons were conducted using the Mann–Whitney U test with Bonferroni correction (α = 0.017). Within–age-group treatment comparisons were also analyzed using the Kruskal–Wallis test followed by pairwise Mann–Whitney U tests with Bonferroni correction. Multivariable linear regression analyses were performed to evaluate factors associated with NRS pain scores, adjusting for age group, treatment modality, surgery type, and BMI in the primary model; complete-case analysis was applied, excluding 6 patients with missing BMI (n = 464 for linear regression and n = 463 for logistic regression due to one additional missing NSAID record). A prespecified sensitivity analysis additionally adjusted for endometriosis (, ), which is associated with nociceptive sensitization. All statistical analyses were performed using Python (version 3.12) with the SciPy (version 1.11), NumPy (version 1.26), and stats models (version 0.14) libraries, and p-value < 0.05 was considered statistically significant. Multicollinearity among covariates was assessed using variance inflation factors (VIF); all VIF values were below 5 (range: 1.06–3.23), confirming acceptable collinearity. To formally test whether the effectiveness of the analgesic regimens differed by age, age group × treatment interaction terms were added to the multivariable model at each time point and their joint significance was assessed with an omnibus F-test. To account for postoperative time and the correlation among repeated measurements within each patient, a repeated-measures model was additionally fitted using ordinary least squares with patient-clustered robust standard errors, incorporating time, age group, treatment, their two-way interactions with time, and covariates. 3 Results 3.1 Patient characteristics A total of 470 patients were included: 257 aged 55 years. Significant differences across age groups were observed in body mass index (BMI), surgery type, pathological diagnosis, and treatment distribution (all p 55-year group vs. 18.7% in the 55 years (98.7%), whereas cystectomy was more frequent in those aged <40 years (84.4%). Given these baseline differences in surgical extent, multivariable regression was subsequently employed to isolate the independent effect of age on postoperative pain. Of the patients initially receiving IV PCA, those who discontinued it before discharge (predominantly because of postoperative nausea and/or vomiting, with fewer cases of dizziness and hypotension) were excluded, as detailed in the flow diagram (Figure 1). Table 1 | Variable | 55 years (n = 75) | p-value | |---|---|---|---|---| | Age (years), median (IQR) | 29.0 (26–33) | 46.5 (43–50) | 64.0 (60–70) | <0.001* | | BMI (kg/m2), mean ± SD | 22.3 ± 3.8 | 23.9 ± 4.0 | 24.2 ± 3.6 | <0.001* | | Surgery type, n (%) | <0.001* | ||| | Cystectomy | 217 (84.4) | 57 (41.3) | 1 (1.3) | | | Adnexectomy | 37 (14.4) | 81 (58.7) | 74 (98.7) | | | Others | 3 (1.2) | 0 (0.0) | 0 (0.0) | | | Pathological diagnosis, n (%) | <0.001* | ||| | Teratoma | 80 (31.1) | 13 (9.4) | 6 (8.0) | | | Endometriosis | 101 (39.3) | 62 (44.9) | 0 (0.0) | | | Borderline/malignant | 4 (1.6) | 5 (3.6) | 8 (10.7) | | | Other benign | 72 (28.0) | 58 (42.0) | 61 (81.3) | | | Treatment group, n (%) | 0.025* | ||| | IV PCA alone | 116 (45.1) | 53 (38.4) | 29 (38.7) | | | CWI + IV PCA | 93 (36.2) | 51 (37.0) | 19 (25.3) | | | CWI alone | 48 (18.7) | 34 (24.6) | 27 (36.0) | | | Hospital stay (days), median (IQR) | 3 (3–3) | 3 (3–3) | 3 (3–3) | 0.520 | Baseline characteristics by age group (n = 470). Values are presented as median (IQR), mean ± SD, or number (%). CWI, continuous wound infiltration; IV PCA, intravenous patient-controlled analgesia. *p 0.05; Table 2 and Figure 2A). By treatment group, the combined CWI + IV PCA regimen consistently produced the lowest NRS scores (Figure 2B). Rescue NSAIDs use was significantly higher in patients aged <40 years during the 0–6 h (p = 0.009), 6–12 h (p = 0.007), and 24–48 h (p = 0.024) postoperative periods (Figure 3). Table 2 | Outcome | 55 years (n = 75) | p-value | |---|---|---|---|---| | NRS pain score, median (IQR) | |||| | 6 h | 3.0 (3.0–4.0) | 3.0 (3.0–4.0) | 3.0 (3.0–4.0) | 0.789 | | 12 h | 2.0 (2.0–3.0) | 2.0 (2.0–3.0) | 2.0 (2.0–3.0) | 0.801 | | 24 h | 2.0 (2.0–2.0) | 2.0 (2.0–2.0) | 2.0 (1.0–2.0) | 0.711 | | 48 h | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 0.479 | | Rescue NSAIDs use, n (%) | |||| | 0–6 h | 74 (28.8) | 22 (15.9) | 14 (18.7) | 0.009* | | 6–12 h | 41 (16.0) | 7 (5.1) | 9 (12.0) | 0.007* | | 12–24 h | 47 (18.3) | 15 (10.9) | 8 (10.7) | 0.076 | | 24–48 h | 43 (16.7) | 15 (10.9) | 4 (5.3) | 0.024* | | Overall | 100 (38.9) | 60 (43.5) | 44 (58.7) | 0.010* | | PONV (antiemetic use), n (%) | |||| | 0–6 h | 105 (40.9) | 52 (37.7) | 36 (48.0) | 0.342 | | Overall | 105 (40.9) | 52 (37.7) | 36 (48.0) | 0.342 | | Pethidine use, n (%) | 5 (1.9) | 3 (2.2) | 4 (5.3) | 0.248 | Unadjusted postoperative outcomes by age group (n = 470). Values are presented as median (IQR) or number (%). NRS, Numeric Rating Scale; NSAID, nonsteroidal anti-inflammatory drug; PONV, postoperative nausea and vomiting. *p < 0.05. Figure 2 Figure 3 3.3 Treatment effectiveness by age group Table 3 and Supplementary Figure S3 present NRS pain scores stratified by both age group and treatment modality. In patients aged <40 years, the combined CWI + IV PCA regimen produced significantly lower NRS scores than both CWI alone and IV PCA alone at 6 h (both p < 0.001) and 12 h (both p < 0.001), whereas differences at 24 h were borderline (p = 0.058 and p = 0.057, respectively). In the 40–55-year group, the analgesic advantage of the combined regimen extended through 24 h, with significantly lower NRS scores compared with both CWI alone and IV PCA alone (both p 55 years, the combined regimen was superior to CWI alone at 6 h (p = 0.001), 12 h (p = 0.005), and 48 h (p = 0.002). In this age group, no statistically significant difference was detected between IV PCA alone and the combined regimen at most time points; however, given the small subgroup size, this absence of a detectable difference cannot be interpreted as evidence of equivalence. Formal age×treatment interaction tests did not reach statistical significance at any time point (omnibus F-test: 6 h p = 0.222, 12 h p = 0.658, 24 h p = 0.107, 48 h p = 0.264) (Supplementary Table S3), indicating that the following within-age-group patterns should be interpreted as exploratory rather than as evidence that treatment effects differ by age. Table 3 | Age <40 years (n = 257) | |||| |---|---|---|---|---| | Postoperative time | CWI alone (n = 48) | IV PCA alone (n = 116) | CWI + IV PCA (n = 93) | p-value | | 6 h | 4.0 (3.0–4.0)a | 3.0 (3.0–4.0)b | 3.0 (3.0–3.0)ab | <0.001* | | 12 h | 3.0 (2.0–3.0) | 3.0 (2.0–3.0)b | 2.0 (2.0–2.0)ab | <0.001* | | 24 h | 2.0 (2.0–2.0) | 2.0 (2.0–2.0) | 2.0 (1.0–2.0) | 0.078† | | 48 h | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 0.674 | | Age 40–55 years (n = 138) | |||| |---|---|---|---|---| | Postoperative time | CWI alone (n = 34) | IV PCA alone (n = 53) | CWI + IV PCA (n = 51) | p-value | | 6 h | 4.0 (4.0–4.0)a | 3.0 (3.0–4.0)ab | 3.0 (3.0–3.0)ab | <0.001* | | 12 h | 3.0 (3.0–3.0)a | 2.0 (2.0–3.0)b | 2.0 (2.0–2.0)ab | <0.001* | | 24 h | 2.0 (2.0–3.0)a | 2.0 (2.0–2.0) | 2.0 (1.0–2.0)ab | 55 years (n = 75) | |||| |---|---|---|---|---| | Postoperative time | CWI alone (n = 27) | IV PCA alone (n = 29) | CWI + IV PCA (n = 19) | p-value | | 6 h | 4.0 (3.5–4.0)a | 3.0 (3.0–3.0) | 3.0 (2.5–3.5)a | <0.001* | | 12 h | 3.0 (2.0–3.0)a | 2.0 (2.0–3.0)b | 2.0 (2.0–2.0)ab | 0.013* | | 24 h | 2.0 (2.0–2.0) | 2.0 (1.0–2.0) | 2.0 (1.0–2.5) | 0.317 | | 48 h | 2.0 (1.0–2.0)a | 1.0 (1.0–2.0) | 1.0 (0.5–1.0)a | 0.007* | NRS pain scores stratified by age group and treatment modality (n = 470). Values are presented as median (IQR). P-values were calculated using the Kruskal–Wallis test across the three treatment groups. Superscript letters indicate post hoc pairwise comparisons with Bonferroni correction (α = 0.017): *p < 0.05. ᵃSignificantly different from IV PCA alone; ᵇsignificantly different from CWI + IV PCA; ᵃᵇsignificantly different from both IV PCA alone and CWI + IV PCA (Bonferroni-corrected significance level, α = 0.017); † indicates a statistical trend (p < 0.10). 3.4 Multivariable analysis: NRS and rescue NSAID After adjusting for treatment modality, surgery type, and BMI (Table 4), patients aged <40 years demonstrated significantly higher NRS pain scores at 24 h (β = + 0.276, p = 0.046), with a borderline trend at 6 h (β = + 0.259, p = 0.053). The combined CWI + IV PCA regimen was the strongest predictor of lower NRS scores at all time points (6 h: β = −0.923, p < 0.001; 24 h: β = −0.422, p < 0.001; 48 h: β = −0.249, p = 0.029). The adjusted between-group difference at 24 h (β ≈ 0.28 on the 0–10 NRS) is well below the reported minimal clinically important difference for postoperative pain (approximately 1.0–2.0 points, and about 1.5 points after gynecologic surgery) and is therefore of limited clinical magnitude despite reaching statistical significance. Table 4 | Variable | NRS 6 h (R2 = 0.161) | NRS 24 h (R2 = 0.051) | |||| |---|---|---|---|---|---|---| | β | 95% CI | p | β | 95% CI | p | | | Age 55 years) | +0.259 | [−0.002, 0.521] | 0.053** | +0.276 | [0.006, 0.546] | 0.046* | | Age 40–55 years (vs. > 55 years) | +0.121 | [−0.118, 0.360] | 0.321 | +0.198 | [−0.049, 0.444] | 0.117 | | IV PCA (vs. CWI alone) | −0.543 | [−0.737, −0.349] | <0.001* | −0.102 | [−0.302, 0.099] | 0.320 | | CWI + PCA (vs. CWI alone) | −0.923 | [−1.122, −0.723] | <0.001* | −0.422 | [−0.628, −0.216] | <0.001* | | Cystectomy (vs. adnexectomy) | −0.055 | [−0.251, 0.142] | 0.586 | −0.152 | [−0.355, 0.051] | 0.144 | | BMI | +0.003 | [−0.016, 0.023] | 0.730 | −0.004 | [−0.024, 0.016] | 0.681 | Multivariable linear regression analysis of NRS pain scores (n = 464).

categories: age >55 years; CWI alone; adnexectomy. Values are presented as β coefficients with 95% confidence intervals (CI). *p < 0.05. **p < 0.10. In multivariable logistic regression analysis of rescue NSAID use at 24–48 h (Supplementary Table S1; Supplementary Figure S1), younger age (<40 years) showed a consistent trend toward higher demand (OR = 3.15, 95% CI: 0.92–10.75, p = 0.067). These findings were consistent in sensitivity analyses additionally adjusting for endometriosis (Supplementary Table S2). In the repeated-measures analysis accounting for postoperative time and within-patient correlation, younger age (<40 years) remained independently associated with higher NRS scores across all time points (β = + 0.172, 95% CI +0.037 to +0.307, p = 0.012). The treatment×time interaction was significant (omnibus F = 6.57, p < 0.001; IV PCA×time p = 0.006, combined×time p < 0.001), whereas the three-way age×treatment×time interaction was not significant (p = 0.078) (Supplementary Table S3). 3.5 PONV and side effects The incidence of PONV did not differ significantly across age groups (p = 0.342). However, CWI alone was associated with the lowest PONV rates at all time points (0–6 h: 24.8% vs. 39.3% vs. 51.5% for CWI alone, combined CWI + IV PCA, and IV PCA alone, respectively; p < 0.001) (Supplementary Figure S2). Pethidine use did not differ significantly across age groups (p = 0.248). 4 Discussion This study evaluated age-related differences in postoperative pain and analgesic requirements after SPA adnexal laparoscopy across three treatment regimens. The principal findings are: (1) younger patients (<40 years) demonstrated higher NRS pain scores at 24 h in multivariable analysis; (2) the combined CWI + IV PCA regimen was associated with the lowest pain scores across all age groups; and (3) although the within-age-group patterns appeared to differ, a formal age×treatment interaction was not statistically significant, so these patterns are descriptive rather than confirmatory. The within-group analysis reveals descriptive, exploratory patterns that should not be interpreted as evidence that age modifies analgesic effectiveness, given the non-significant interaction tests. In reproductive-age patients (<40 years), CWI + IV PCA's advantage is concentrated in the acute phase (6 h and 12 h), after which the three regimens converge. The descriptive pattern is consistent with a concentration of the combined regimen's relative advantage in the early postoperative period among younger patients and a more sustained separation in the 40–55-year group; however, because the formal interaction was not significant, these observations should be regarded as hypothesis-generating. In the >55 years group, the pattern shifts further: CWI alone has persistently high NRS, while IV PCA alone appears sufficient, making the combined approach less necessary from an analgesic standpoint — though CWI alone remains preferable from a PONV and opioid-sparing perspective (). A sensitivity analysis additionally adjusting for endometriosis was performed, given its unique role as the only pathological diagnosis in this cohort with an established neuroinflammatory mechanism for altering pain perception — including peripheral sensitization and central dorsal horn hyperexcitability — that may lower the postoperative pain threshold independently of surgical trauma (, ). Notably, endometriosis itself was not independently associated with higher NRS scores at any time point (NRS 24 h: β = −0.135, p = 0.134) or with greater late rescue NSAID demand (OR = 0.69, p = 0.240), possibly because SPA cystectomy produces less nociceptive input than deep excision procedures and central sensitization may have a greater impact on chronic rather than acute pain trajectories (, ). Critically, the age-related effects were preserved and directionally strengthened in the sensitivity analysis (NRS 24 h: β = + 0.289, p = 0.037; NSAID 24–48 h: OR = 3.26, p = 0.059), suggesting that differential endometriosis prevalence did not fully explain the observed age-related association, and that younger age remained independently associated with higher postoperative pain after adjustment for endometriosis (, ). The opioid-sparing and PONV-reducing effects of CWI, consistent with our previous studies (, , ), were maintained across all age groups. CWI alone remains a reasonable option for older patients in whom opioid-related adverse effects are a concern (). Future prospective studies are warranted to determine whether extended CWI duration or the addition of supplemental analgesics during the 24–48 h postoperative period may provide additional benefit in younger patients. This study has several limitations, including its retrospective, non-randomized design, the use of age as a surrogate for menopausal status, the relatively small number of patients aged >55 years, the lack of data on total fentanyl consumption, and the absence of validated assessments of central sensitization. These limitations prevented direct evaluation of the potential contribution of sensitization in patients with endometriosis. Another potential source of confounding was the marked difference in surgical procedures across age groups, reflecting the clinical tendency for postmenopausal patients to undergo adnexectomy more frequently than cystectomy. Although the extent of tissue trauma may differ between these procedures, the multivariable analysis adjusted for surgery type, and younger age remained independently associated with higher NRS pain scores at 24 h. This finding suggests that the observed age-related pain pattern may reflect age-specific biological factors, including estrogen-modulated nociception, rather than differences in surgical procedure alone. Because per-patient actual fentanyl consumption was unavailable and IV PCA dosing was adjusted for age, part of the observed age–pain relationship may reflect differences in administered opioid dose, and opioid-sparing interpretations should be made cautiously. In addition, patients who discontinued IV PCA were excluded, and because these discontinuations were driven predominantly by opioid-related nausea/vomiting, this exclusion may bias the side-effect (and potentially the efficacy) comparison in favor of the IV PCA–containing groups. Pain was assessed only at rest and not on movement, and the >55-year subgroups were small, precluding any equivalence interpretation. Finally, as a secondary analysis of a cohort overlapping with our previous reports, the present findings share the same source population. In conclusion, although unadjusted NRS pain scores did not differ among age groups, younger patients aged <40 years experienced significantly greater postoperative pain at 24 h after adjustment for relevant clinical factors. The combined CWI and IV PCA regimen was associated with the lowest pain scores across age groups, although a formal age×treatment interaction was not statistically significant. These findings may inform individualized multimodal analgesic planning but do not establish that age should directly guide regimen selection; prospective studies are warranted. Statements Data availability statement The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Ethics statement Written informed consent was not obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article because Written informed consent for publication was not obtained because this retrospective study contains no identifiable personal information, images, or other data that could reveal the identity of individual participants. The requirement for informed consent was waived by the institutional review boards of the participating institutions. Author contributions EP: Methodology, Visualization, Conceptualization, Project administration, Formal analysis, Writing – original draft. MY: Visualization, Writing – original draft, Resources, Investigation, Validation. JiK: Investigation, Validation, Data curation, Writing – original draft, Resources, Visualization. JuK: Conceptualization, Supervision, Writing – review & editing, Project administration. Funding The author(s) declared that financial support was not received for this work and/or its publication. Conflict of interest The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Generative AI statement The author(s) declared that generative AI was not used in the creation of this manuscript. Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us. Publisher’s note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Supplementary material The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2026.1951712/full#supplementary-material

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adnexal disease, age, continuous wound infiltration, patient-controlled analgesia, postoperative pain, rescue analgesic, single-port access laparoscopy Citation Paik ES, Yu M, Kang J and Kang J-H (2026) Article title age-related differences in postoperative pain after single-port access adnexal laparoscopy: a three-arm analgesic strategy comparison. Front. Med. 13:1951712. doi: 10.3389/fmed.2026.1951712 Received 29 July 2026 Revised 28 September 2026 Accepted 09 October 2026 Published 29 October 2026 Volume 13 - 2026 Edited by Roberto Tozzi, University of Padua, Italy Reviewed by Thomas Rolf Erdmann, Secretaria de Estado da Saúde de Santa Catarina, Brazil Merve Bulun Yediyıldız, Istanbul Kartal Dr.Lutfi Kirdar Education and Research Hospital, Türkiye Updates Copyright © 2026 Paik, Yu, Kang and Kang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. *Correspondence: Jun-Hyeok Kang [email protected] Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.