Postoperative Pain Management
Conditions
Keywords
Vaginal Hysterectomy, Bupivacaine, Analgesia
Brief summary
This randomized controlled study evaluates whether injecting bupivacaine into the vaginal cuff during vaginal hysterectomy reduces postoperative pain. Vaginal hysterectomy is commonly performed for benign gynecologic conditions. Although it is associated with less pain compared to abdominal surgery, postoperative discomfort may still affect recovery and patient satisfaction. In this study, 48 women undergoing elective vaginal hysterectomy were randomly assigned to two groups. In the intervention group, 0.25% bupivacaine was injected bilaterally into the vaginal cuff after closure. In the control group, no local anesthetic injection was administered. All patients received the same standard postoperative pain management protocol. Pain levels were measured using the Visual Analog Scale (VAS) at 1, 3, 6, 12, and 24 hours after surgery. Additional analgesic consumption and possible complications were also recorded. The study aims to determine whether vaginal cuff bupivacaine infiltration improves early postoperative pain control.
Detailed description
This prospective, single-center, randomized controlled trial was conducted to evaluate the effect of bilateral vaginal cuff infiltration with 0.25% bupivacaine on postoperative pain following vaginal hysterectomy performed for benign gynecologic indications. Vaginal hysterectomy, although minimally invasive, may still be associated with significant postoperative discomfort. The uterus and surrounding structures receive innervation from the uterosacral plexus (Lee-Frankenhauser plexus), which plays a role in postoperative pain transmission. Local anesthetic infiltration targeting this anatomical region may reduce nociceptive signaling and improve early postoperative pain control. A total of 48 women aged 35-75 years scheduled for elective vaginal hysterectomy were randomized using a sealed-envelope method into two parallel groups: Intervention group (n=24): Bilateral infiltration of 10 mL 0.25% bupivacaine into the lateral aspects of the vaginal cuff following cuff closure. Control group (n=24): Standard surgical procedure without local anesthetic infiltration. All procedures were performed under general anesthesia. Postoperative analgesia was administered according to institutional standard protocol. Pain intensity was assessed using the Visual Analog Scale (VAS) at postoperative 1, 3, 6, 12, and 24 hours. The primary outcome was postoperative pain intensity measured by VAS scores. Secondary outcomes included total analgesic consumption within the first 24 hours, intraoperative and postoperative complications, and length of hospital stay. The study was completed after enrollment of 40 participants, and outcomes were analyzed to determine the efficacy and safety of vaginal cuff bupivacaine infiltration in reducing early postoperative pain following vaginal hysterectomy.
Interventions
0.25% bupivacaine (10 mL) was bilaterally infiltrated into the lateral aspects of the vaginal cuff following cuff closure during vaginal hysterectomy.
Sponsors
Havva Betül Bacak
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Single-blind study. Participants were blinded to group allocation. The surgeon and clinical staff were aware of the treatment assignment due to the nature of the intervention.
Intervention model description
Participants were randomly assigned in a 1:1 ratio to one of two parallel groups using a sealed-envelope method. The intervention group received bilateral vaginal cuff infiltration with 10 mL of 0.25% bupivacaine after cuff closure, while the control group underwent the same surgical procedure without local anesthetic infiltration. The study was conducted as a single-center, open-label randomized controlled trial.
Eligibility
Sex/Gender
FEMALE
Age
35 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Women aged 35 to 75 years Scheduled for elective vaginal hysterectomy for benign gynecologic indications (e.g., uterine fibroids, adenomyosis, abnormal uterine bleeding, pelvic organ prolapse) Able to provide written informed consent
Exclusion criteria
Known or suspected gynecologic malignancy (endometrial, cervical, or uterine) Allergy or hypersensitivity to local anesthetics, especially bupivacaine Prior pelvic radiotherapy or major pelvic surgery resulting in altered anatomy Conditions preventing vaginal cuff injection (e.g., extensive scarring, active infection) Inability to reliably assess pain (e.g., impaired consciousness, dementia, severe psychiatric disorder) Refusal to sign informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity Measured by Visual Analog Scale (VAS) | 1, 3, 6, 12, and 24 hours postoperatively | Pain intensity was assessed using a 10-point Visual Analog Scale (VAS), where 0 indicates no pain and 10 indicates the worst imaginable pain. Scores were recorded at predefined postoperative time points to evaluate the effectiveness of vaginal cuff bupivacaine infiltration |
Countries
Turkey (Türkiye)
Outcome results
None listed