title: Utility of preemptive local analgesia in vaginal hysterectomy.
abstract: OBJECTIVE
  Our purpose was to determine whether preemptive administration of long-acting local anesthetics before vaginal hysterectomy will improve postoperative pain.
  
  
  METHODS
  A blinded, randomized, trial of paracervical injection of 0.5% bupivacaine with epinephrine or normal saline solution placebo with epinephrine was conducted. Verbal analog pain scores were collected at 1, 2, 3, 4, 6, and 24 hours after surgery. Morphine use in the postanesthesia care unit and by patient-controlled morphine analgesia was recorded.
  
  
  RESULTS
  Twenty patients were enrolled. Nine were randomized to bupivacaine. There was no difference between groups regarding age, length of surgery, blood loss, or length of stay. Pain scores were lower in the bupivacaine group by analysis of variance (P=.03). Total morphine and patient-controlled analgesia morphine was significantly less in patients receiving bupivacaine (P=.01 and.04).
  
  
  CONCLUSIONS
  Paracervical block with a 0.5% bupivacaine with 1:200,000 epinephrine before vaginal hysterectomy is associated with lower pain scores and a reduction in morphine requirements after surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Medical Center Annex, Greenville, NC 27858, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: O'Neal
authors.forename: T
authors.initials: T
authors.lastname: Beste
authors.forename: D P
authors.initials: DP
authors.lastname: Shackelford
mesh_terms: D000328:Adult; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine; D004837:Epinephrine