Paracervical Injection and Opioid Use After Vaginal Hysterectomy for Prolapse

Effect of Paracervical Block on Postoperative Opioid Use in Vaginal Hysterectomy for Prolapse: a Randomized, Placebo-Controlled Trial

The goal of the study to see if giving a numbing medicine around the cervix (called a paracervical block) during vaginal hysterectomy with prolapse repair helps people feel less pain and need fewer strong pain medicines afterward.

The main question it aims to answer is:

• Does receiving a paracervical block at the time of vaginal hysterectomy with prolapse repair reduce postoperative opioid use?

Researchers will compare opioid use in participants who receive the an injected numbing medicine (bupivacaine with lidocaine) to those that receive a saltwater liquid placebo.

Participants will:

• Receive either an injection of the numbing medicine (bupivacaine with lidocaine) or saltwater liquid placebo after they are asleep but before any other parts of the surgery are done
• Record and report pain medications used for 7 days after surgery
• Report pain scores before discharge from the post anesthesia recovery area on day of surgery as well as 1 and 7 days after surgery
• Complete a surgical recovery questionnaire during 6 week postoperative visit
• Complete a one page multiple-choice test on pelvic organ prolapse

Secondary outcomes are to:

1. Compare postoperative pain scores in patients undergoing vaginal hysterectomy for prolapse repair who receive an intraoperative paracervical block compared to placebo
2. Compare surgical recovery times in patients undergoing vaginal hysterectomy for prolapse repair who receive an intraoperative paracervical block compared to placebo.
3. Examine incidence of adverse events in patients undergoing vaginal hysterectomy for prolapse repair who receive intraoperative paracervical block compared to placebo

Inclusion Criteria:

• Individuals undergoing vaginal hysterectomy with concomitant prolapse repair procedure

Exclusion Criteria:

• Non-English speaking
• Weight less than 50 kg
• Allergy to bupivacaine
• Pregnant