Aim: To evaluate the analgesic effica-cy of presurgical uterosacral ligaments (USLs) infiltration with local anesthet-ic in context of vaginal hysterectomy (VH) performed under general anes-thesia.
Patients and Methods: This prospec-tive randomized, parallel group, place-bo-controlled, triple-blinded, superior-ity trial, conducted at Benha Universi-ty hospital and El-Hayat Specialized center, Benha, Egypt, from February 2013 to March 2015. 80 women includ-ed in this trial, 28 women had pelvic organ prolapse (POP) undergoing VH while the remaining 52 women were had either dysfunctional uterine bleed-ing (DUB) or uterine fibroids (UF) undergoing non-descent vaginal hys-terectomy (NDVH), each group were randomized separately into presurgi-cal local anesthesia (PLA) (20 ml bupi-vacaine 0.5%, in USLs) injection group (no= 40, 14 with POP, 26 with DUB or UF) or group in whom 20 ml normal saline injected in same fashion at ratio of 1 :1. The main outcomes measure were average total Nalbu-phine consumption and postoperative pain evaluated by visual analogue scale (VAS) score as well as percentage of women with pain free in immediate and early postoperative period while the subsidiary outcomes were inci-dence of postoperative nausea, vomit-ing, narcotic side effects as well as hos-pital stay, time to first ambulation and time to first flatus.
Results: The average total Nalbuphine consumption were 46% lower in PLA group compared to placebo (P< 0.0001) and the mean pain VAS at recovery room, 2 hours, 6 hours, was 32.5% (p= 0.003), 30% (P= 0.003), 32.5% (P= 0.0001) lower respectively in PLA group in comparison to place-bo. Also the incidence of nausea and vomiting (P = 0.03, P = 0.03) were low-er in PLA group and the time to first ambulation and time to first flatus were shorter in PLA group (P< 0.0001, P < 0.0001).
Conclusion: Presurgical local anes-thetic uterosacral ligaments infiltra-tion with 20ml bupivacaine 0.5% in context with vaginal hysterectomy is effective in reducing postoperative pain scores as well as reduce the aver-age total nalbuphine consumption. |
