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 fluid 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 significantly 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 efficient in reducing postoperative pain after vaginal hysterectomy.