Abstract
Purpose
To evaluate the effect of a protocol of local anesthesia and epinephrine associated with sedo-analgesia on post-TVT-O pain in comparison with infiltration of saline and epinephrine.
Methods
Forty-two patients undergoing TVT-O were randomized into two groups to receive periurethral infiltration with epinephrine only (group A, n = 21) or with epinephrine plus 1 % lidocaine hydrochloride (group B, n = 21). Post-operative pain was assessed using a visual analog scale (VAS) from 0 (absence of pain) to 10 (maximum pain possible), 1, 6, 12 and 24 h after the procedure. The total amount of analgesia was recorded and the proportion of women reporting a pain VAS score ≥4, 1 h after the procedure was calculated. ANOVA for repeated measures and Bonferroni correction, the Student’s t test for independent samples, the Mann–Whitney U test, the Fisher exact test, or the χ 2 test for parametric was used.
Results
Pain level was significantly lower in group B 1 (p = 0.01) and 6 h (p = 0.05) after surgery, but not 12 and 24 h after the procedure. No significant difference was observed in the proportion of women requesting analgesia and in the total dosage of analgesics between the two groups. A significant higher proportion of women in group A reported a pain VAS score higher than four 1 h after surgery in comparison with patients in group B.
Conclusions
This randomized study seems to indicate that systematic infiltration before TVT-O positioning with local anesthetic may reduce immediate post-operative pain.
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Acknowledgments
The authors wish to thank the anesthesiology staff of our institution (Rita Anfora, Salvatore Buono, Vincenzo Maffei, Rosamaria Matano, Francesco Marino, Ferdinando Pasquariello, Eugenio Piscicelli, Biagio Raucci, and Fabio Rispoli) who actively supported this study and without whom it would have never been performed. The authors also would like to acknowledge the work of the midwife Rosa Tammaro, who prepared the solutions for each patient following randomization and helped in the procedures.
Conflict of interest
Giovanni A. Tommaselli is consultant for Ethicon and Solace Therapeutics. Carmine Nappi accepted paid travel expenses from Ethicon. The other authors state that they have no conflict of interest.
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Tommaselli, G.A., Di Carlo, C., Formisano, C. et al. Effect of local infiltration analgesia on post-operative pain following TVT-O: a double-blind, placebo-controlled randomized study. Arch Gynecol Obstet 290, 283–289 (2014). https://doi.org/10.1007/s00404-014-3186-8
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DOI: https://doi.org/10.1007/s00404-014-3186-8