Local Infiltration Analgesia in Urogenital Prolapse Surgery: A Prospective Randomized Double-blind, Placebo-Controlled Study

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Abstract

Local infiltration analgesia is an established technique that provides postoperative analgesia for a variety of surgical techniques. When used to manage postoperative pain following surgery for urogenital prolapse, it is a safe alternative to opioids, which can cause several adverse effects. No placebo-controlled studies have evaluated the use of systematic local anesthetic infiltration for urogenital prolapse surgery.

This randomized, double-blind, placebo-controlled study evaluated the analgesic effect of high-volume infiltration analgesia in women undergoing urogenital prolapse surgery and describes the infiltration technique in detail. Participants were 48 patients undergoing posterior wall repair and perineorraphy at a university hospital. All women received either a standardized systematic intraoperative infiltration regimen (high-volume [26 mL] ropivacaine 1% with epinephrine [n = 23]) or saline (n = 22). The technique ensured uniform delivery to all tissues during the procedure. Primary study outcome measures were pain and opioid requirements for 24 hours, time spent in the postanesthesia care unit (PACU), and time to first mobilization.

Use of the high-volume local infiltration analgesia technique significantly reduced pain at rest as well as pain during coughing and movement for the first 4 hours (P < 0.001–0.006). Patients in the ropivacaine group had reduced opioid requirements and spent less time in the PACU (P < 0.001 and P < 0.001, respectively) and had a shorter time to first mobilization (P < 0.014).

These findings show that this systematic high-volume intraoperative infiltration technique provides effective analgesia in patients undergoing posterior wall repair and perineorraphy and facilitates early recovery.

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