In women scheduled to undergo vaginal hysterectomy, the use of preemptive local analgesia seems to be valuable to reduce opioid usage and alleviate postoperative pain.

In order to assess the effects of preemptive local analgesia (LA) on postsurgery pain and perioperative outcomes for women having a vaginal hysterectomy, a systematic review and meta-analysis was conducted.

The following four electronic databases were thoroughly explored: Clinicaltrials.gov, Cochrane CENTRAL Register of Controlled Trials, Scopus, and MEDLINE. All randomized controlled studies that described the results of patients who had a vaginal hysterectomy for benign gynecological illnesses or pelvic floor problems and received local infiltration analgesia were incorporated. The current meta-analysis comprised 5 trials with 277 women who underwent vaginal hysterectomy (138 volunteers in the LA group vs. n = 199 volunteers in the no-LA group).

Mean pain scores were considerably lower in the LA group compared to the non-LA group at both 30 minutes to 2 hours and 3-6 hours postoperatively. When compared to the non-LA group, the use of morphine and other narcotic opioids up to 24 hours after surgery was considerably lower in the LA group (n = 197, mean difference [MD]: -9.47 mg).

Preemptive local anesthetics infiltration during vaginal hysterectomy appears to be advantageous, particularly in terms of opioid utilization and short-term postsurgery pain.