The effect of atorvastatin as an adjuvant analgesic on prostaglandin E2 levels, pain score, and postsurgical opioid consumption in radical hysterectomy surgery

BACKGROUND: Acute postoperative hysterectomy pain can cause hypernociception. Pre-emptive adjuvant analgesic administration is expected to reduce postoperative pain, opioid requirements, and inflammation levels due to tissue damage caused by hysterectomy surgery. Atorvastatin produces anti-inflammatory and analgesic effects by inhibiting the release of inflammatory cytokines. Atorvastatin shows analgesic, anti-inflammatory effects, and the role of inhibition of cytokine release from tissues and stimulation of nitric oxide (NO) production.METHODS: A single-blind randomized clinical trial was conducted at RSPTN Hasanuddin University Makassar and Wahidin Sudirohusodo Hospital from August 2023 to June 2024.RESULTS: A total of 45 patients underwent hysterectomy at Wahidin Sudirohusodo Hospital and network hospitals. The study subjects were randomly divided into three groups consisting of a group given atorvastatin 40 mg of 15 people, a group receiving atorvastatin 20 mg of 15 patients and a group receiving placebo of 15 people. Administration of atorvastatin 40 mg reduced pain levels at 2, 6, and 24 hours postoperatively and decreased prostaglandin E2 (PGE2) levels. In addition, all study subjects did not receive postoperative opioid rescue.CONCLUSIONS: Atorvastatin doses of 20 and 40 mg/day were able to reduce PGE2 levels in posthysterectomy patients. Posthysterectomy patients experienced mild to moderate pain that did not require opioids as postoperative analgesics.