Preemptive local analgesia at vaginal hysterectomy: a systematic review

A Randomized Controlled Trial Assessing the Effect of Preoperative Ibuprofen Administration on Postoperative Pain Reduction Following Miniscrew Insertion

OBJECTIVE

To evaluate the impact of preoperative oral ibuprofen premedication as a preemptive analgesia protocol on postoperative pain following the insertion of a single miniscrew insert.

METHODS

A randomized, single-blind, placebo-controlled parallel-group trial design was adopted. A total of 68 patients seeking miniscrew insert placement were recruited based on inclusion and exclusion criteria. Patients were randomly assigned in a 1:1 ratio to either the ibuprofen group or the control group, with 34 patients in each group. The ibuprofen group and the control group received 300 mg of ibuprofen sustained-release capsules and a placebo, respectively, 30 min before surgery. Postoperative analgesics were administered as needed. Pain scores at 2, 4, 6, 8, 12, and 24 h postoperatively were recorded using the Numerical Rating Scale (NRS), and the postoperative analgesic consumption was documented.

RESULTS

A total of 68 patients (34 in the control group and 34 in the preemptive analgesia group) completed the trial. No adverse events such as nausea or vomiting occurred in any of the patients. The preemptive analgesia group exhibited significantly lower pain scores at 2, 4, 6, and 8 h postoperatively [2 (0,3), 0 (0,2), 0 (0,0), 0 (0,0.25), respectively] compared to the control group [3 (2,5), 3 (2,4), 2 (0.75,4), 1 (0,3), respectively] (P = 0.0396, P = 0.0067, P = 0.0111, P = 0.0299). The proportions of patients requiring additional analgesics within 2-24 h postoperatively were 17.6% (6/34) in the preemptive analgesia group and 64.7% (22/34) in the control group, with a statistically significant difference between the two groups (P = 0.013).

CONCLUSION

Preemptive analgesia with ibuprofen can effectively reduce postoperative pain following miniscrew insert placement and represents a safe and effective perioperative pain management strategy.

TRIAL REGISTRATION

The UK's Clinical Study Registry; ISRCTN68332234 (Retrospectively registered); 20/12/2024.

Enhanced recovery after surgery (ERAS) in prolapse repair: A prospective study on pre-emptive uterosacral/cervical block

OBJECTIVE

Enhanced recovery after surgery (ERAS) protocols have been introduced in gynecology. Postoperative pain management after vaginal procedures remains a relevant issue. In the present study we aimed to evaluate the effectiveness of pre-emptive uterosacral/cervical block (PUCB) for postoperative pain control in patients with uterovaginal prolapse undergoing vaginal hysterectomy and pelvic floor repair. We also evaluated the impact on the length of recovery.

METHODS

This was a pilot study analyzing 40 women who underwent pelvic organ prolapse repair through uterosacral ligament suspension. Patients who chose to undergo PUCB were considered as cases, otherwise as controls. After general or spinal anesthesia induction, the treatment group received the PUCB with ropivacaine plus clonidine injections at 2, 4, 8, and 10 o'clock of the cervix. The control group did not receive additional treatment. Pain intensity was measured at rest and after forceful cough at 1, 4, 8, 12, 24, and 48 h postoperatively.

RESULTS

We found a significant reduction in pain values at 1 h (rest and forceful cough) and 24 h (forceful cough) in the PUCB group. The incidence of moderate/severe pain was inferior in the PUCB group at 1 h (rest) and 24 h (rest and forceful cough). There were no differences in terms of the use of rescue opioids (0% vs. 5%; P = 0.311) and length of hospital stay (2.5 ± 0.6 vs. 2.3 ± 0.6; P = 0.180).

CONCLUSIONS

For the first time, we demonstrated the impact of pre-emptive uterosacral/cervical block on pain control up to 24 h after surgery. Clonidine as a sensory blockade extender appears promising in enhancing the efficacy of local anesthetics.

Exploring the rationale of performing vaginal hysterectomy under local anaesthesia: A single-centre experience

INTRODUCTION

Vaginal hysterectomy (VH) is usually performed under general (GA) or regional anaesthesia. In recent years, the possibility of performing vaginal hysterectomy under local anaesthesia (LA) has also been explored. Our aim was to compare intraoperative and early postoperative outcomes in women who underwent VH under LA with intravenous sedation or GA.

METHODS

In this retrospective study, we collected data of patients who underwent VH at our department from June 2021 to December 2022. For every patient, the following data was obtained: hospitalisation duration, type of anaesthesia (LA or GA), accompanying procedures, the dosage of used local anaesthetic in the LA group, maximal pain score for each day of hospitalisation after the procedure, procedure duration, intraoperative blood loss, and postoperative complication rate. Data was analysed using the SPSS Statistics programme. Statistical significance was set at p < 0.05.

RESULTS

Seventy patients were included in the study. The mean age was significantly higher in the LA group compared to GA group (73.8 ± 8.0 years vs. 67.1 ± 9.3 respectively, p-value = 0.003). LA was associated with statistically lower pain scores in the first two days after the procedure (p = 0.003), and shorter procedure duration (p-value <0.001) as well as hospitalisation duration (p < 0.001). Furthermore, the cumulative dosage of different analgesics used during hospitalisation was higher in the GA group.

CONCLUSIONS

Our results show that LA is a feasible option for patients undergoing VH. Vaginal surgical procedures under LA could be especially beneficial for older patients with medical comorbidities in whom GA would be particularly hazardous.