A Randomized Controlled Trial Comparing the Efficacy of Bupivacaine Injection in Vaginal Vault and Paracervical Region Versus Vaginal Vault Infiltration with Bupivacaine After Total Laparoscopic Hysterectomy.

Abstract

Background: Demand for laparoscopic surgeries have been on the rise in all surgical departments in the past few decades. Hysterectomy, one of the most common gynaecological procedures is preferred laparoscopically these days owing to their multiple benefits.

Aim: To compare the efficacy and safety of Bupivacaine injection in Vault versus Paracervical Block and Vault Infiltration with Bupivacaine after Total Laparoscopic Hysterectomy.

Materials and methods: Thirty women undergoing total laparoscopic hysterectomy for benign gynaecology conditions were recruited and randomised into two comparable groups. Group I had 15 patients who received vaginal vault infiltration with 10 ml of 0.5% Bupivacaine. Group II had 15 patients who received paracervical block before surgery and vaginal vault infiltration after vault closure with 10 ml of 0.5% Bupivacaine. All patients were treated with injection paracetamol and NSAIDS. VAS score and need for additional analgesia were recorded at 1 h, 2 h and 6 h post-surgery. Any patient who reported a VAS score of more than 4 were given injection tramadol as rescue analgesia and recorded.

Results: All the baseline characteristics were comparable except dysmenorrhoea (P = 0.017) and BMI (0.034) which showed statistically significant difference between the two groups. The VAS scores were significantly lower in combined group (Group I) when compared with vault infiltration group (Group II) across all time points (P- < 0.001). The need for rescue analgesia at 1-h post-surgery was lower in both the groups and comparable among the two groups (P = 0.483). The need for rescue analgesia at 2 h {P- < 0.001} and 6 h post-surgery {P- < 0.001} were significantly lesser in Group II (combined group). No patients required additional analgesia in group II.

Conclusion: Two novel methods of administering local anaesthetic to alleviate post TLH pain when used in conjunction can significantly reduce pain and analgesia requirements making shorter hospital stay and early return to daily activities possible hence reducing cost per procedure.