Utility of preemptive local analgesia in vaginal hysterectomy

M G O'Neal, T Beste, D P Shackelford
American Journal of Obstetrics and Gynecology 2003, 189 (6): 1539-41; discussion 1541-2

OBJECTIVE: Our purpose was to determine whether preemptive administration of long-acting local anesthetics before vaginal hysterectomy will improve postoperative pain.

STUDY DESIGN: A blinded, randomized, trial of paracervical injection of 0.5% bupivacaine with epinephrine or normal saline solution placebo with epinephrine was conducted. Verbal analog pain scores were collected at 1, 2, 3, 4, 6, and 24 hours after surgery. Morphine use in the postanesthesia care unit and by patient-controlled morphine analgesia was recorded.

RESULTS: Twenty patients were enrolled. Nine were randomized to bupivacaine. There was no difference between groups regarding age, length of surgery, blood loss, or length of stay. Pain scores were lower in the bupivacaine group by analysis of variance (P=.03). Total morphine and patient-controlled analgesia morphine was significantly less in patients receiving bupivacaine (P=.01 and.04).

CONCLUSION: Paracervical block with a 0.5% bupivacaine with 1:200,000 epinephrine before vaginal hysterectomy is associated with lower pain scores and a reduction in morphine requirements after surgery.


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