Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH).Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n=353) or TLH (n=407) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery.Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%,P<0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%,P=0.09), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%,P<0.0001), 6–14 days (35% versus 15%,P<0.0001), and 15–60 days (15% versus 9%,P=0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62,P<0.0001) and four weeks (0.89 versus 0.63,P=0.01) following surgery.Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.