Photo Credit: trumzz

The following is a summary of “Post-Operative Pain After Pelvic Organ Prolapse Surgery (POPPOP): A Double Blind Randomised Multicentre Study to Assess the Effect of Local Anaesthesia During Vaginal Hysterectomy,” published in the April 2025 issue of Obstetrics & Gynecology by Thiagamoorthy et al. 

Researchers conducted a retrospective study to compare local anaesthetic with adrenaline (LAA) and normal saline for hydrodissection during vaginal hysterectomy.  

They designed a double-blind, 2-parallel group, multicentre randomized controlled trial (RCT). A total of 217 women scheduled for vaginal hysterectomy were screened across 5 centers between March 2015 and December 2018. Among them, 156 were recruited. Participants were randomized to receive either Bupivacaine 0.25% or 0.5% with adrenaline 1:200000, or normal saline. The pain was evaluated using the short-form McGill Pain Questionnaire (SFMcGill) at 3-time points (‘pre-operation,’ ‘same day 3–6 h post-op’, and ‘morning after surgery’). The primary outcome was post-operative pain assessed by SFMcGill. Secondary outcomes included estimated blood loss (EBL), dissection ease, ooze severity, change in hemoglobin (Hb) levels pre- and post-surgery, operating time, inpatient stay duration, and post-operative morbidity incidence.  

The results showed no demographic differences between groups and LAA led to significantly smaller increases in pain scores compared to placebo between pre-operative and same-day post-operative periods (7.105, P < 0.001), and from pre-operative to next day post-operative (1.334, P< 0.001). Placebo use was linked to higher intra-operative blood loss (difference in estimated blood loss 110 mL, P< 0.001), greater ooze severity (visual analogue scale difference 5.01, P< 0.001), and increased dissection difficulty (visual analogue scale difference 2.96, P< 0.001). No significant differences were observed in Hb, PCV, or post-operative analgesia use (P> 0.05). The placebo group experienced more complications (5 vs 0, P= 0.02).  

Investigators concluded that LAA infiltration, when compared to normal saline, resulted in reduced intra-operative blood loss, improved ease of dissection, and decreased same- and next-day pain and complications during vaginal hysterectomy under general anesthesia. 

Source: obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.18162