Randomized trial of preemptive local analgesia in vaginal surgery

Abstract

Preemptive analgesia in vaginal surgery has had conflicting efficacy reported in the existing literature. This study was designed to clarify the usefulness of preemptive local analgesia (PLA) in patients undergoing vaginal hysterectomy. A prospective, randomized, double-blinded trial of PLA in 90 women undergoing vaginal hysterectomy was conducted. PLA consisted of 20 ml of 0.5% bupivacaine with 1:200,000 epinephrine injected in a paracervical-type fashion. Total narcotic use and pain (using a visual analog scale (VAS)) was recorded at 30 min, 3, 12, and 24 h postoperatively. The mean total dose of narcotic was significantly less in the PLA group versus the placebo group (P = 0.009) at every time point postoperatively. Additionally, the mean pain VAS 30 min and 3 h postoperatively was 43% (P = 0.003) and 33% (P = 0.02) lower, respectively, in the PLA group. PLA with bupivacaine prior to vaginal hysterectomy is associated with significantly lower pain scores and a reduction in narcotic use postoperatively.

The effectiveness of Bupivacaine as a pre-emptivepudendal block among patients undergoing vaginal surgeries: meta-analysis of randomized controlled trials

“…[17,18] However, overall there was significant heterogeneity between studies and no evidence of a difference in favour of quicker return to normal activity between the PNB and control arms. Some of our results were similar to reports provided by previous studies [16,37] that investigated the use of PNB to reduce the postoperative pain scores and analgesic requirement, but contradictory to other reports [24] . In a trial [16] that evaluated the analgesic effect of 0.25% Bupivacaine on gluteal pain among patients who underwent sacrospinous ligament colpopexy.…”

“…At full text screening, twelve studies were excluded. [27][28][29][30][31][32][33][34][35][36][37] . Six studies included patients undergoing abdominal hysterectomy, laparoscopy with perineal/vaginal procedures or obstetric surgery [27][28][29][30][31][32] ; 3 studies were trial registrations of full texts that were already included in the review [33][34][35] ; 2 studies used different interventions e.g.…”

“…Six studies included patients undergoing abdominal hysterectomy, laparoscopy with perineal/vaginal procedures or obstetric surgery [27][28][29][30][31][32] ; 3 studies were trial registrations of full texts that were already included in the review [33][34][35] ; 2 studies used different interventions e.g. sacrocolpopexy [36,37] ; and 1 study assessed a different outcome -gluteal pain instead of perineal pain. [16] One study included non-eligible participants and assessed different outcomes from this review.…”

Postoperative Pain and Preemptive Local Anesthetic Infiltration in Hallux Valgus Surgery

“…10 Preemptive local anesthetic wound infiltration is widely used in general surgery, gynecology or neurosurgery. 2,23,24,35 For example, the preoperative local infiltration of bupivacaine reduces pain and opioid use and, consequently, the incidence of nausea or vomiting in the first 24 hours after inguinal hernia surgery. 29 Moreover, this method of preemptive analgesia decreases postoperative pain sensation, limits the amount of fentanyl use during surgery, and reduces the demand for opiates in patients undergoing mastectomy in breast cancer.…”

Pre-Emptive Analgesia for Postoperative Pain Control

“…[39] At 30 minutes and at 3 hours after surgery, patients who received pre-emptive analgesia had significantly lower pain scores (both p £ 0.02 vs placebo). [39] At 30 minutes and at 3 hours after surgery, patients who received pre-emptive analgesia had significantly lower pain scores (both p £ 0.02 vs placebo).…”