Vaginal Cuff Bupivacaine Injection for Postoperative Pain

This prospective, single-center, randomized controlled trial was conducted to evaluate the effect of bilateral vaginal cuff infiltration with 0.25% bupivacaine on postoperative pain following vaginal hysterectomy performed for benign gynecologic indications.

Vaginal hysterectomy, although minimally invasive, may still be associated with significant postoperative discomfort. The uterus and surrounding structures receive innervation from the uterosacral plexus (Lee-Frankenhauser plexus), which plays a role in postoperative pain transmission. Local anesthetic infiltration targeting this anatomical region may reduce nociceptive signaling and improve early postoperative pain control.

A total of 48 women aged 35-75 years scheduled for elective vaginal hysterectomy were randomized using a sealed-envelope method into two parallel groups:

Intervention group (n=24): Bilateral infiltration of 10 mL 0.25% bupivacaine into the lateral aspects of the vaginal cuff following cuff closure.

Control group (n=24): Standard surgical procedure without local anesthetic infiltration.

All procedures were performed under general anesthesia. Postoperative analgesia was administered according to institutional standard protocol. Pain intensity was assessed using the Visual Analog Scale (VAS) at postoperative 1, 3, 6, 12, and 24 hours.

The primary outcome was postoperative pain intensity measured by VAS scores. Secondary outcomes included total analgesic consumption within the first 24 hours, intraoperative and postoperative complications, and length of hospital stay.

The study was completed after enrollment of 40 participants, and outcomes were analyzed to determine the efficacy and safety of vaginal cuff bupivacaine infiltration in reducing early postoperative pain following vaginal hysterectomy.

Inclusion criteria

• Women aged 35 to 75 years

Scheduled for elective vaginal hysterectomy for benign gynecologic indications (e.g., uterine fibroids, adenomyosis, abnormal uterine bleeding, pelvic organ prolapse)

Able to provide written informed consent

Exclusion criteria

Known or suspected gynecologic malignancy (endometrial, cervical, or uterine)

Allergy or hypersensitivity to local anesthetics, especially bupivacaine

Prior pelvic radiotherapy or major pelvic surgery resulting in altered anatomy

Conditions preventing vaginal cuff injection (e.g., extensive scarring, active infection)

Inability to reliably assess pain (e.g., impaired consciousness, dementia, severe psychiatric disorder)

Refusal to sign informed consent