BACKGROUND: It is known that laparoscopic surgery is associated with less pain than open surgery in many studies. We wanted to evaluate the postoperative pain by using intravenous patient-controlled analgesia (IV-PCA) in patients undergoing laparoscopic assisted vaginal hysterectomy (LAVH) or abdominal total hysterectomy (ATH). METHODS: Ninety one women with uterine myoma were prospectively assigned to undergo either LAVH (n = 49) or ATH (n = 42). IV-PCA was used for postoperative pain control in both groups. Pain scores were assessed using a visual analogue scale (VAS) and cumulative PCA-drug consumption and incidences of nausea and vomiting were recorded in 1, 2, 4, 24, 48 hours after surgery. RESULTS: There were no differences in terms of patient's age, BMI and total operation time between the both groups. Pain scores and the demand of analgesics of the IV-PCA in 1, 2, 4, 24, and 48 hours after surgery were not significantly different in both groups. Incidences of nausea and vomiting after surgery were more common in LAVH than ATH especially within 4 hours. CONCLUSIONS: The present study demonstrates that LAVH requires adequate postoperative pain control as ATH during the first 48 hours after surgery, and the effective prevention of PONV is required in LAVH compared with ATH.