Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy: a randomized, placebo-controlled trial

OBJECTIVE: To assess the effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy, and describe the technique in detail.

DESIGN: A randomized, double-blind, placebo-controlled study following the CONSORT criteria.

SETTING: A university hospital.

PATIENTS: 37 patients undergoing vaginal hysterectomy.

METHODS: Patients received high-volume (50 ml) ropivacaine 0.50% (n=20) or saline (n=17) infiltration using a systematic technique ensuring uniform delivery to all tissues incised, handled or instrumented during the procedure.

MAIN OUTCOME MEASURES: Pain, nausea, vomiting and opioid requirements were assessed for 32 hours as well as time spent in the post-anesthesia care unit and time to first mobilization.

RESULTS: Pain at rest was significantly reduced after 1, 4 and 8 hours in the ropivacaine group (p≤ 0.001 - 0.01). Pain during coughing was significantly reduced after 1 and 4 hours (p≤ 0.001 and p≤ 0.003), while pain during movement was significantly reduced after 4 hours (p≤ 0.02). Opioid requirements and time spent in the post-anesthesia care uni were significantly reduced in the ropivacaine group (p<0.001 and p<0.001, respectively), as well as the time to first mobilization (p<0.001).

CONCLUSION: Intra-operative systematic local infiltration analgesia reduces postoperative pain in patients undergoing vaginal hysterectomy, facilities mobilization and improves early recovery.