Contrasting the Effectiveness of Bupivacaine Injection in Vaginal Vault and Paracervical Region Versus Vaginal Vault Infiltration with Bupivacaine After Total Laparoscopic Hysterectomy

The demand for laparoscopic surgeries has been increasing across surgical departments over the past few decades. Hysterectomy, a frequently performed gynecological operation, is now often conducted laparoscopically due to its numerous advantages.

The study aims to evaluate the effectiveness and safety of Bupivacaine injection administered in the vaginal vault compared to a paracervical block followed by vault infiltration with Bupivacaine after total laparoscopic hysterectomy.

A total of thirty women scheduled for total laparoscopic hysterectomy due to benign gynecological conditions were enrolled and randomly assigned to two similar groups. Group I consisted of 15 patients who received vaginal vault infiltration with 10 ml of 0.5% Bupivacaine. Group II included 15 patients who received a paracervical block before surgery and vault infiltration post-closure, also with 10 ml of 0.5% Bupivacaine. All participants were given injectable paracetamol and NSAIDs for pain management. Pain levels were assessed using a Visual Analog Scale (VAS) at 1, 2, and 6 hours post-surgery, with additional analgesia provided as needed.

The results demonstrated:

Baseline characteristics were similar between groups, except for dysmenorrhea and BMI, which showed significant differences.
VAS scores were significantly lower in Group I (vault infiltration only) compared to Group II (combined method) at all measured times.
The requirement for rescue analgesia one hour after surgery was similar in both, but the need decreased significantly in Group II at 2 hours and 6 hours, with no patients in Group II needing additional analgesia.

To conclude, the combination of two innovative local anesthetic administration methods to manage post-total laparoscopic hysterectomy pain significantly reduces pain levels and the need for further analgesics, leading to shorter hospital stays and quicker returns to normal activities, thereby lowering overall procedure costs.

Source: Kaloni KS, Roy KK, Garg D, et al. A Randomized Controlled Trial Comparing the Efficacy of Bupivacaine Injection in Vaginal Vault and Paracervical Region Versus Vaginal Vault Infiltration with Bupivacaine After Total Laparoscopic Hysterectomy. J Obstet Gynecol India. 2025. https://doi.org/10.1007/s13224-024-02086-1

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