Steven Radtke1, Todd Boren2, Stephen Depasquale2. 1. Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, Tennessee (all authors). Electronic address: dr.radtke@gmail.com. 2. Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, Tennessee (all authors).
Abstract
STUDY OBJECTIVE: To determine if performing a paracervical block with .5% bupivacaine before laparoscopic hysterectomy reduces postoperative pain. DESIGN: Double-blind randomized controlled trial (Canadian Task Force classification I). SETTING: University-affiliated hospital. PATIENTS: Women aged between 18 and 65 years scheduled to undergo total laparoscopic hysterectomy for benign indications. INTERVENTIONS:Eligible patients were allocated to control or treatment groups using block randomization. Surgeon administered injection of either .9% NaCl or .5% bupivacaine into the cervical stroma at the 3 and 9 o'clock positions after general anesthesia was established. Pain was assessed using a visual analog scale with a range from 0 to 10 at 30 and 60 minutes after extubation. MEASUREMENTS AND MAIN RESULTS: Forty-one patients met criteria for analysis. Based on randomization, 20 were allocated to the control arm and 21 to the treatment arm. We used Student t and Pearson χ2 tests to ensure both groups were homogenous to age (46.5 vs 46, p = .87), body mass index (35 vs 32.7 kg/m2, p = .45), minutes of operating time (132.5 vs 119.7, p = .11), specimen weight (138.8 vs 160.6 g, p = .44), and history of cesarean section (p = .58). Pain scores at 30 minutes (5.7 vs 3.2, p = .01) and 60 minutes (5.9 vs 2.3, p <.001) were significantly lower in the treatment arm. We dichotomized results depending on whether patients had successful postoperative pain control, defined as an average pain score of 4 or less. The χ2 test was used for comparison. Using this definition 25% of patients had successful pain control in the placebo group versus 71.4% in the treatment group. This was statistically significant (p = .003). Mean length of hospital stay (.65 vs .86 days, p = .44) was not statistically different. CONCLUSION: Performing a paracervical block with .5% bupivacaine before laparoscopic hysterectomy significantly reduces immediate postoperative pain. (ClinicalTrials.gov no.: NCT03027661.).
RCT Entities:
STUDY OBJECTIVE: To determine if performing a paracervical block with .5% bupivacaine before laparoscopic hysterectomy reduces postoperative pain. DESIGN: Double-blind randomized controlled trial (Canadian Task Force classification I). SETTING: University-affiliated hospital. PATIENTS: Women aged between 18 and 65 years scheduled to undergo total laparoscopic hysterectomy for benign indications. INTERVENTIONS: Eligible patients were allocated to control or treatment groups using block randomization. Surgeon administered injection of either .9% NaCl or .5% bupivacaine into the cervical stroma at the 3 and 9 o'clock positions after general anesthesia was established. Pain was assessed using a visual analog scale with a range from 0 to 10 at 30 and 60 minutes after extubation. MEASUREMENTS AND MAIN RESULTS: Forty-one patients met criteria for analysis. Based on randomization, 20 were allocated to the control arm and 21 to the treatment arm. We used Student t and Pearson χ2 tests to ensure both groups were homogenous to age (46.5 vs 46, p = .87), body mass index (35 vs 32.7 kg/m2, p = .45), minutes of operating time (132.5 vs 119.7, p = .11), specimen weight (138.8 vs 160.6 g, p = .44), and history of cesarean section (p = .58). Pain scores at 30 minutes (5.7 vs 3.2, p = .01) and 60 minutes (5.9 vs 2.3, p <.001) were significantly lower in the treatment arm. We dichotomized results depending on whether patients had successful postoperative pain control, defined as an average pain score of 4 or less. The χ2 test was used for comparison. Using this definition 25% of patients had successful pain control in the placebo group versus 71.4% in the treatment group. This was statistically significant (p = .003). Mean length of hospital stay (.65 vs .86 days, p = .44) was not statistically different. CONCLUSION: Performing a paracervical block with .5% bupivacaine before laparoscopic hysterectomy significantly reduces immediate postoperative pain. (ClinicalTrials.gov no.: NCT03027661.).