title: Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy: a randomized, placebo-controlled trial.
abstract: OBJECTIVE
  To assess the effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy, and describe the technique in detail.
  
  
  METHODS
  A randomized, double-blind, placebo-controlled study following the CONSORT criteria.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Thirty-seven patients undergoing vaginal hysterectomy.
  
  
  METHODS
  Patients received high-volume (50 mL) ropivacaine 0.50% (n = 20) or saline (n = 17) infiltration using a systematic technique ensuring uniform delivery to all tissues incised, handled or instrumented during the procedure.
  
  
  METHODS
  Pain, nausea, vomiting and opioid requirements were assessed for 32 h as well as time spent in the post-anesthesia care unit and time to first mobilization.
  
  
  RESULTS
  Pain at rest was significantly reduced after one, four and eight hours in the ropivacaine group (p ≤ 0.001-0.01). Pain during coughing was significantly reduced after one and four hours (p ≤ 0.001 and p ≤ 0.003), and pain during movement was significantly reduced after four hours (p ≤ 0.02). Opioid requirements and time spent in the post-anesthesia care unit were significantly reduced in the ropivacaine group (p < 0.001 and p < 0.001, respectively), as well as the time to first mobilization (p < 0.001).
  
  
  CONCLUSIONS
  Intra-operative systematic local infiltration analgesia reduces postoperative pain in patients undergoing vaginal hysterectomy, facilities mobilization and improves early recovery.
authors.affiliation: Department of Anesthesiology, Hvidovre University Hospital, Copenhagen University, Copenhagen, Denmark.
authors.forename: Ana-Marija
authors.initials: AM
authors.lastname: Hristovska
authors.forename: Billy B
authors.initials: BB
authors.lastname: Kristensen
authors.forename: Marianne A
authors.initials: MA
authors.lastname: Rasmussen
authors.forename: Yvonne H
authors.initials: YH
authors.lastname: Rasmussen
authors.forename: Lisbeth B
authors.initials: LB
authors.lastname: Elving
authors.forename: Christian V
authors.initials: CV
authors.lastname: Nielsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000698:Analgesia / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine; D013997:Time Factors
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Vaginal hysterectomy surgery; local infiltration analgesia; multimodal analgesia; postoperative pain treatment; ropivacaine