Preoperative pudendal block with liposomal and plain bupivacaine reduces pain associated with posterior colporrhaphy: a double-blinded, randomized controlled trial

Multimodal approach to postoperative pain is clinically important

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We appreciate the author's interest in our original research regarding preoperative pudendal block with mixed 1.3% liposomal bupivacaine and 0.25% plain bupivacaine at the time of posterior colporrhapy during pelvic reconstructive surgery. 1 Although our statistically significant vaginal pain differences were small, the overall pain was reduced for our patient population. We were unable to find any reference to "satisfactory pain scores" in the citation provided in the Letter to the Editors.

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“…Our median pain scores with interquartile ranges are depicted by postoperative day in Table 2 and Figure 4 in the original manuscript. 1 As stated in our article, in a field of medicine based on quality of life, we believe that any modifications that can be done to mitigate patient discomfort are clinically important. We agree that patient satisfaction is very important and also agree that this could be an area of future study.Overall, low postoperative opioid usage has been found in studies surrounding female pelvic medicine and reconstructive surgeries.…”

The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks

“…Of the 1996 trials identified from the literature search, 27 met the inclusion criteria, 18–44 accounting for a total of 2122 patients. Figure 1 presents the PRISMA flow diagram showing the literature search results and Fig.…”

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

“…In a trial of patients undergoing mid-urethral sling placement, liposomal bupivacaine was found to decrease pain compared to injection of normal saline but pain scores were low in both groups 81 . An RCT concluded that preoperative regional pudendal block with a combination of liposomal and plain bupivacaine provided more effective vaginal pain control than plain bupivacaine alone for reconstructive surgery that included posterior colporrhaphy 82 but, if injected into the lateral posterior vaginal wall and perineal body, does not provide a significant decrease in postoperative pain or decrease narcotic medication usage compared to saline 83 . However, in midurethral sling and laparoscopic surgery, there was no benefit of liposomal bupivacaine compared to saline or bupivacaine for improving pain control or reducing opioid use 84,85 .…”