[Postoperative pain and sex/gender-current findings of the past decade].

BACKGROUND

Sex and gender affect pain perception but their role in postoperative pain remains unclear and is not addressed in current guidelines.

OBJECTIVES

This scoping review summarizes evidence from the past ten years on sex-related differences in postoperative pain (patient-reported outcome (PRO), opioid consumption) and evaluates their relevance.

MATERIALS AND

METHODS

Systematic search in Medline® (March 2015-18 August 2025); 106 studies included.

PRIMARY OUTCOME: acute pain intensity (≤ 3 weeks).

SECONDARY OUTCOMES: subacute/chronic postsurgical pain and opioid use.

RESULTS

Of the 106 studies included, 44 covered acute pain. In most of them women reported higher pain intensity-particularly after thoracic surgery and orthopedic procedures; several analyses confirmed female sex as an independent predictor for postoperative pain. Studies related to subacute pain (5/106) reported slightly higher pain intensity ratings in women, and the results in chronic pain studies (44/106) were mixed, with more severe pain in women after visceral surgeries. While results for acute opioid consumption (16/106) were heterogeneous, for the long-term postoperative course, studies (9/106) consistently reported a higher persistence of analgesic/opioid use in women.

CONCLUSIONS

Sex is a relevant factor regarding pain-related outcome parameters after surgery, and its impact is influenced by the postoperative timeframe and type of surgery. Further studies with standardized, sex-stratified endpoints are required to enable gender-sensitive patient care.