Compared to plain bupivacaine alone, preoperative regional pudendal block with liposomal + plain bupivacaine is highly effective in reducing vaginal pain during pelvic reconstructive surgery that includes posterior colporrhaphy.

A study was carried out for comparing the effect of plain bupivacaine alone vs its combination with liposomal bupivacaine on vaginal pain in participants undergoing a posterior colporrhaphy, either independently or along with other abdominal or vaginal reconstructive approaches.

Overall, 120 subjects were divided to receive 20 ml of either 1.3% liposomal + 0.25% plain bupivacaine (study group, n=60) or 20 mL of 0.25% plain bupivacaine (control group, n=60) prior to initiating surgery.

After inducing anesthesia, a pudendal nerve block was carried out as per the standard technique with the help of a pudendal kit. Estimation of postoperative vaginal pain with the aid of visual analog scale (VAS) on postsurgery days one, two, and three was the major endpoint. The secondary endpoints were the total analgesic use through postsurgery day three, postsurgery voiding and defecatory dysfunction, and the effect of vaginal pain on the quality of life factors.

In this double-blinded, randomized controlled trial, no profound differences were witnessed in demographic data, including the baseline vaginal pain. Compared to control group, the study group illustrated decreased postoperative vaginal pain scores at all time points. The median vaginal pain scores for the study and control groups on postoperative days 1, 2 and 3 are shown in Table 1:

In both study and control groups, the vaginal pain scores elevated from post-surgery day one to post surgery days two and three. In the study group, a considerable decline was witnessed in ibuprofen and acetaminophen use. Regarding total opioid consumption through postoperative day three, no considerable difference was noted between the groups. No profound differences were reported in successful voiding trials, return of bowel function, or quality of life factors (activity, mood, sleep, stress).

Given the substantial drop in vaginal pain in the study group, liposomal plus plain bupivacaine appears to be a promising adjunct for multimodal pain control in females undergoing pelvic reconstructive surgery.