Postoperative Belladonna and Morphine Suppositories in Vaginal Surgery

Randomized Clinical Trial of Postoperative Belladonna and Morphine Suppositories in Vaginal Surgery

Our primary aim is to determine whether the routine use of belladonna and morphine suppositories will improve pain control following vaginal surgery. Treatment will begin immediately following surgery and every 8 hours for 16 hours.

Minimizing postoperative pain is vital to a successful surgical recovery. Inadequate pain control may result in nausea, vomiting, an extended hospital stay, and reduced patient satisfaction. Oral and parenteral narcotics are commonly used for pain relief and their use may exacerbate the incidence of sedation, nausea, and vomiting; ultimately delaying convalescence. Previous studies have demonstrated that rectal analgesia following surgery results in lower pain scores and less intravenous morphine consumption. Belladonna and opium suppositories are routinely prescribed at our institution and their efficacy has not been confirmed.

A prospective, randomized, double-blind, placebo-controlled trial will be undertaken using belladonna and opium rectal suppositories following vaginal surgery. Treatment will begin immediately following surgery and continue every 8 hours for a total of 3 doses.

Inclusion Criteria:

• Scheduled for elective vaginal surgery requiring general anesthesia at the Mayo Clinic Hospital. This would include a vaginal hysterectomy with culdoplasty or post-hysterectomy prolapse repair, including culdoplasty with or without anterior/posterior repair.

Exclusion Criteria:

• Participation in another trial using an investigational product.
• Pregnancy.
• Scheduled for a non-vaginal surgical procedure.
• Scheduled for a robotic hysterectomy.
• Scheduled to have combined surgeries (vaginal surgery plus another non-vaginal surgery).
• There is a known hypersensitivity to belladonna and/or opium.
• Contraindication to narcotic use.
• Chronic pain with preoperative pain score greater than 4 out of 10 points.
• Clinically significant substance abuse.
• Mental condition that may impair the ability to provide study assessments.