Intrarectal diazepam following pelvic reconstructive surgery: a double-blind, randomized placebo-controlled trial

Area of Science:

• Gynecology
• Urogynecology
• Pelvic Reconstructive Surgery

Background:

• Vaginal hysterectomy with native tissue pelvic reconstruction typically results in low overall postoperative pain.
• However, immediate postoperative pain management can be challenging, potentially hindering same-day discharge.
• Intrarectal diazepam, known for its utility in pelvic pain management, has not been previously studied in this surgical context.

Purpose of the Study:

• To evaluate the efficacy of diazepam rectal suppositories in alleviating early postoperative pain following hysterectomy and vaginal reconstruction for pelvic organ prolapse.

Main Methods:

• A double-blind, randomized, placebo-controlled trial was conducted.
• Participants received either a 10-mg intrarectal diazepam suppository or a placebo post-surgery.
• Pain scores (Visual Analog Scale), satisfaction, and medication use were assessed at baseline, postoperative day 1, and 2 weeks.

Main Results:

• No significant difference in early postoperative vaginal pain scores was observed between the diazepam and placebo groups (P=.285).
• Immediate postoperative narcotic usage (MME) also did not differ significantly between the groups (P=.202).
• Patients in the placebo group reported higher satisfaction with pain control at two weeks postoperatively.

Conclusions:

• The administration of a 10-mg diazepam rectal suppository post-surgery did not improve early postoperative pain or reduce narcotic requirements.
• While overall pain levels were low, the placebo group showed greater satisfaction with pain management at two weeks.
• The addition of diazepam to the postoperative regimen is not recommended based on these findings.