The effect of preemptive local anesthesia on postoperative pain following vaginal hysterectomy: A randomized controlled trial

Abstract

Introduction: The effect of local anesthesia on postoperative pain, in operations performed vaginally has been scarcely studied. Although the results were encouraging, the studies populations were relatively small, and the indications for hysterectomy were not homogenous.We aimed to study the effect of preemptive local anesthetic on postoperative pain following vaginal hysterectomy.Methods: This was a double-blinded, randomized, controlled trial. Women who undergone elective vaginal hysterectomy were included. Solutions of either Bupivacaine-Hydrochloride 0.5%, or Sodium-Chloride 0.9% as a placebo, were prepared prior to surgery, according to randomization. The chosen solution was injected before incision, in a circumferential manner, to the cervix. The amount of uid administered was 10 ml. When colporrhaphy was also performed, an additional 5 ml of solution were injected in the midline of the vaginal wall prior to each incision line. We conformed to the CONSORT recommendations.By utilizing the 10 cm Visual-analogue-scale (VAS) we assessed post-operative pain at rest at 3, 8, and 24 hours, and during ambulation at 8 and 24 hours.Results: A total of 30 women were included in each group. The level of postoperative pain, as assessed by VAS, was not signi cantly different between the groups, in all points of time. In addition, there was no difference between the groups in opioid based analgesics during recovery, nor in postoperative analgesic use.Conclusion: Preemptive local anesthesia was not shown to be e cient in reducing postoperative pain after vaginal hysterectomy.

Standardized 10‐step approach for successfully performing a hysterectomy via vaginal natural orifice transluminal endoscopic surgery

“…As the pressure of the pneumoperitoneum is lower than for conventional laparoscopic hysterectomy and no abdominal incision is made, women typically report lower pain scores compared with women undergoing a conventional laparoscopic approach 12,13 . We found conflicting data in studies examining whether the addition of a local anesthetic in the peri‐cervical infiltration at the beginning of a vaginal hysterectomy is of importance in postoperative pain 14,15 . This factor has not been individually studied in vNOTES.…”

“… 12 , 13 We found conflicting data in studies examining whether the addition of a local anesthetic in the peri‐cervical infiltration at the beginning of a vaginal hysterectomy is of importance in postoperative pain. 14 , 15 This factor has not been individually studied in vNOTES.…”