Use of Intraperitoneal Bupivacaine After Prolapse Surgery: A Double-Blind RCT

Despite evidence that intraperitoneal local anesthetics can have a positive effect on patients' postoperative recovery, such use in urogynecology remains underinvestigated.

The purpose of this study was to evaluate the effects of intraperitoneal bupivacaine without epinephrine on postoperative pain control in patients undergoing surgery for pelvic organ prolapse (POP).

This double-blind randomized controlled trial compared intraperitoneal bupivacaine versus placebo for postoperative pain control in patients undergoing POP surgery. The primary outcome was pain scores based on a 10-point numeric rating scale and visual analog scale (NRS-VAS) at 4 hours after surgery. Secondary outcomes included pain scores based on the NRS-VAS collected at 8, 12, and 24 hours after surgery, postoperative opiate consumption during inpatient stay, time to first narcotic dose, and hospital length of stay.

Ninety-one participants were randomized into treatment (n = 44) or placebo (n= 47) groups. No differences in demographic or baseline characteristics, surgical time, estimated blood loss, or intraoperative complications were observed between groups. The primary outcome, NRS-VAS pain scores at 4 hours after surgery, showed no statistically significant difference between groups. Similarly, no significant differences were found in NRS-VAS scores at 8, 12, or 24 hours after surgery, total postoperative opiate consumption, time to first narcotic dose during inpatient stay, or hospital length of stay.

No differences in pain scores, opiate consumption, time to first narcotic dose, or hospital length of stay were observed between the treatment and placebo groups. The routine use of intraperitoneal bupivacaine following POP surgery appears to have limited clinical utility.