Paracervical block during vaginal natural orifice transluminal endoscopic surgery reduces postoperative pain and analgesic consumption: a retrospective cohort study.

Abstract

Introduction: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) for bilateral tubal ligation may cause notable early postoperative pain, leading to opioid use. Paracervical block (PBC) could support analgesia within enhanced recovery after surgery (ERAS) pathways.

Aim: The aim of this study was to evaluate whether the use of PBC improved postoperative pain scores, reduced analgesic requirements, and affected short-term sexual function.

Materials and methods: In this retrospective cohort study, 43 women underwent bilateral tubal ligation via vNOTES at the Iğdır Dr. Nevruz Erez State Hospital. Twenty patients received PBC with 10 ml of 0.5% bupivacaine injected at the 3 and 9 o'clock cervicovaginal junction, whereas 23 women served as controls. Outcomes included visual analog scale (VAS) pain scores at 1, 6 and 24 hours postoperatively, intra- and postoperative opioid use, and Female Sexual Function Index (FSFI) scores preoperatively and 1 month after surgery.

Result: PBC significantly lowered 24-hour VAS scores (mean [SD], 3 vs 4; P = 0.02) and intraoperative opioid requirement (mean [SD], 0 vs 10 mg morphine equivalent; P = 0.01). Total postoperative analgesic consumption and length of hospital stay were comparable. FSFI scores 1 month after surgery were higher in the PBC group than the controls (mean [SD], 206 vs 14.5 respectively; P = 0.001), indicating better short-term sexual function recovery.

Conclusion: Incorporating PBC into vNOTES enhances early pain control and decreases intraoperative opioid use without delaying discharge, while favorably influencing short-term sexual function. PBC is a simple, effective adjunct that aligns with ERAS goals in minimally-invasive gynecologic surgery.