1316 Extended Release Local Anesthetic for Postsurgical Vaginal Pain after Posterior Colporrhaphy and Perineorrhaphy: A Randomized Controlled Study

Study Objective To evaluate the effect of intraoperative infiltration of liposomal bupivacaine on postoperative vaginal pain among patients undergoing pelvic reconstructive surgery including posterior colporrhaphy and/or perineorrhaphy. Design Randomized, double-blind, placebo-controlled trial. Setting Academic hospital. Patients or Participants 127 women undergoing posterior colporrhaphy and/or perineorrhaphy were screened, and 72 were enrolled and included in the final analysis: 37 (51.4%) randomized to liposomal bupivacaine and 35 (48.6%) to placebo. Interventions Liposomal bupivacaine or normal saline placebo was injected into the posterior vaginal compartment and perineal body using a systematic technique. Measurements and Main Results The primary outcome was vaginal pain as measured by a visual analog scale (VAS). Participants completed twice daily pain and medication diaries starting on postoperative day 0 until the evening of postoperative day 3. Surgical and demographic characteristics were similar. Median VAS was not statistically different at any time point (p=0.81). Median NRS recorded in PACU were lower for the intervention group (0.0 [IQR 2.0] vs 1.5 [IQR 4.0], p=0.05). There were no differences seen in any other secondary outcomes. There were no differences in narcotic use (37.5 vs 37.5 mme, p=0.51), time to first opioid administration (89.5 vs 68.0 minutes, p=0.56), number of antiemetic doses required (2.0 vs 3.0, p=0.07), median hospital length of stay (21.9 vs 24.0 hours, p=0.98), median length of stay in PACU (100 vs 93 minutes, p=0.32), proportion of patients who had a bowel movement within first 3 postoperative days (59.5 vs 65.7% p=0.36) or who passed their voiding trial prior to hospital discharge (59.5 vs 45.7%, p=0.24). There were no differences in patient satisfaction or in adverse events. Conclusion In this study of pelvic reconstructive surgeries with posterior colporrhaphy and/or perineorrhaphy, there were no differences in pain scores, nor any secondary outcomes, between liposomal bupivacaine and placebo injected into the posterior vaginal compartment.