Vaginal Vault Infiltration with Bupivacaine for Postoperative Pain Control after Total Laparoscopic Hysterectomy: A Randomized control trial

Objectives

The objective of this study was to assess the effect of local infiltration of anesthetic to the vaginal vault on postoperative pain after total laparoscopic hysterectomy.

Materials and Methods

This was a single-center, randomized trial. Women assigned to laparoscopic hysterectomy were randomly divided into two groups. In the intervention group (n = 30), the vaginal cuff was infiltrated with 10 ml of bupivacaine, whereas the control group (n = 30) did not receive local anesthetic infiltration to vaginal vault. The primary outcome measure was to analyze the efficacy of bupivacaine infiltration in the study group by comparing the postoperative pain in both the groups at 1, 3, 6, 12, and 24 h using pain visual analog scale (VAS). The secondary outcome was to measure the need for rescue opioid analgesia.

Results

Group I (intervention group) had lesser mean VAS score at 1^st, 3^rd, 6^th, 12^th, and 24 h compared to Group II (control group). There was an additional requirement of opioid analgesia for postoperative pain in Group II than in Group I, which was statistically significant (P < 0.05).

Conclusion

Injection of local anesthetic into the vaginal cuff increased the number of women experiencing only minor pain after laparoscopic hysterectomy and decreased postoperative opioid usage and its side effects. Local anesthesia of the vaginal cuff is safe and feasible.

Acute Abdomen during Pregnancy with Fibroid Uterus: Red Degeneration or Torsion?

During pregnancy, red degeneration and torsion of subserosal fibroid may present with acute abdomen, creating a diagnostic dilemma. Red degeneration of fibroid during pregnancy responds to conservative management, whereas torsion of a subserosal fibroid requires emergency myomectomy. This case report describes a clinical scenario wherein difficulties were encountered in diagnosing the cause of acute abdomen during mid-trimester in a pregnant woman with fibroid uterus and the role of imaging to differentiate the above two clinical conditions. A 26-year-old primigravida with subserous fibroid presented at 19 weeks with pain in abdomen and vomiting. She was provisionally diagnosed with red degeneration and treated conservatively for 48 hours. Her symptoms persisted, and hence torsion of the subserous fibroid was suspected. However, no pedicle was visualised on 2D Ultrasound (USG). Therefore, Magnetic Resonance Imaging (MRI) was done, which revealed the pedicle, and accordingly, the decision for emergency laparotomy was taken, and the fibroid was excised. Histopathology revealed infarction of leiomyoma. The pregnancy continued in a regular course.