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Title: Preemptive Local Analgesia Reduces Pain and Narcotic Use After Vaginal Hysterectomy: Presented at AUGS
URL: http://www.pslgroup.com/dg/22AFA2.htm
Doctor's Guide
September 5, 2008

By Laura Gater

CHICAGO -- September 5, 2008 -- Use of preemptive local analgesia (PLA) during a vaginal hysterectomy reduces patients' pain scores 3 hours after surgery and patients' total narcotic use over 24 hours, according to a prospective, randomised, double-blind study.

Jaime B. Long, MD, Mayo Clinic Arizona, Phoenix, Arizona, presented the study results on September 5 at the American Urogynecologic Society 19th Annual Scientific Meeting (AUGS).

Dr. Long and colleagues enrolled 90 patients undergoing vaginal hysterectomy with McCall culdoplasty to assess the effect on postoperative pain of a preemptive paracervical block using a long-acting local anaesthetic. Half of the patients were randomised to receive PLA and half to receive a placebo.

The PLA group received paracervical injections of 0.5% bupivacaine 10 mL with 1:200,000 epinephrine 4 minutes prior to incision and again prior to McCall culdoplasty sutures. The primary outcome measure was the visual analogue score (VAS) 30 minutes postoperatively. All adverse events were tracked for 6 weeks after surgery.

The mean dose of narcotic was 30% lower in the PLA group.

The mean pain 30 minutes after surgery was 43% lower in the PLA group than in the placebo group; it was 33% lower 3 hours after surgery in the PLA group than in the placebo group. At 12 and 24 hours, mean pain scores were equivalent for the 2 treatment groups.

Adverse events reported during the 6-week postoperative period were urinary retention, postoperative nausea and vomiting, and pneumonia.

Dr. Long concluded that PLA with bupivacaine prior to vaginal hysterectomy is associated with significantly lower pain scores and a reduction in narcotic use postoperatively.


[Presentation title: Preemptive Local Analgesia in Vaginal Surgery. Paper 44]

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