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Vaginal hysterectomy with anterior and posterior repair for pelvic organ prolapse under local anesthesia: results of a pilot study

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A Commentary to this article was published on 30 May 2020

Abstract

Introduction and hypothesis

Vaginal hysterectomy (VH) and pelvic floor repair (PFR) for the surgical management of pelvic organ prolapse (POP) are usually performed under regional anesthesia. The aim of this study is to evaluate the feasibility of performing VH and PFR under local anesthesia and to compare postoperative pain and patient recovery parameters with patients undergoing the same surgical procedure under regional anesthesia.

Methods

This was a single-center prospective cohort study of women with advanced POP. The standard care group consisted of 20 patients who underwent VH and PFR under a combined spinal-epidural (CSE) block, whereas the local anesthesia group consisted of 20 patients who underwent VH and PFR under local anesthesia and intravenous sedation. Primary outcomes included the intensity of postoperative pain and the percentage of patients with moderate/severe pain. Secondary outcomes included percentage of patients who used opioids, incidence of nausea/vomiting, level of sedation, and patient satisfaction rate.

Results

The median pain intensity at rest was significantly lower in the local anesthesia group at 2 h, 4 h, and 8 h postoperatively (median values: 0 vs 1.9, 0 vs 4.1, and 1 vs 2.7 respectively). The percentage of patients needing opioids was significantly lower for the local anesthesia group (35% vs 95%, p = 0.002). The proportion of patients presenting nausea and vomiting symptoms in the two groups was similar.

Conclusions

Local anesthesia for patients undergoing VH and PFR has been shown to be a viable alternative to regional anesthesia, offering reduced postoperative pain and less opioid use for the first 8 h.

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Abbreviations

ASA:

American Society of Anesthesiologists

CSE:

Combined spinal-epidural

ICS:

International Continence Society

IV:

Intravenous

PCA:

Patient-controlled analgesia

PFR:

Pelvic floor repair

POP:

Pelvic organ prolapse

RSS:

Ramsay sedation scale

UDS:

Multichannel urodynamics

VAS:

Visual analogue scale

VH:

Vaginal hysterectomy

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Authors and Affiliations

  1. First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, “Alexandra” Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece

    Stavros Athanasiou, Dimitrios Zacharakis, Themos Grigoriadis, Theodoros Papalios & Eleni Pitsouni

  2. Department of Anaesthesiology, “Alexandra” Hospital, Athens, Greece

    Dimitrios Valsamidis & Sofia Hadzillia

Authors
  1. Stavros Athanasiou
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  2. Dimitrios Zacharakis
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  3. Themos Grigoriadis
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  4. Theodoros Papalios
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  5. Eleni Pitsouni
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  6. Dimitrios Valsamidis
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  7. Sofia Hadzillia
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Contributions

S. Athanasiou: protocol/project development, manuscript writing, data analysis;D. Zacharakis: protocol/project development, manuscript writing, data analysis;T. Grigoriadis: protocol/project development, data collection, data analysis;T. Papalios: data collection;P. Eleni: protocol/project development, statistical analysis;D. Valsamidis: protocol/project development, manuscript editing;S. Hadzillia: protocol/project development, manuscript editing.

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Correspondence to Stavros Athanasiou.

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Athanasiou, S., Zacharakis, D., Grigoriadis, T. et al. Vaginal hysterectomy with anterior and posterior repair for pelvic organ prolapse under local anesthesia: results of a pilot study. Int Urogynecol J 31, 2109–2116 (2020). https://doi.org/10.1007/s00192-020-04326-0

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  • DOI: https://doi.org/10.1007/s00192-020-04326-0

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