Randomized double-blind trial of short- versus long-acting analgesia at the sacrospinous ligament

Introduction and hypothesisPain control is a key component of postoperative care; our objective was to evaluate if use of long-acting local anesthesia at the sacrospinous ligament leads to decreased postoperative pain versus short-acting local anesthesia in patients undergoing sacrospinous ligament fixation.MethodsWomen 18years old undergoing sacrospinous ligament fixation to treat pelvic organ prolapse were eligible to participate in this randomized trial. Enrolled patients were randomized 1:1 to one of two study arms: (1) lidocaine arm (LA) or (2) liposomal bupivacaine arm (LBA). Patients in the LA received 30ml 0.5% lidocaine with 1:200,000 epinephrine local injection at the sacrospinous ligament. Patients in the LBA received 20ml 1.3% bupivacaine liposomal mixed with 10ml 0.5% bupivacaine at the sacrospinous ligament. All patients received 50ml 0.5% lidocaine with 1:200,000 epinephrine for anterior and/or posterior colporrhaphy. The primary outcome of this study was postoperative buttock pain.ResultsOf the 37 patients enrolled, 33 completed study procedures. Mean age ( SD) was 62.3years (+/- 11.6) in the LA and 66.8years (+/- 14.4) in the LBA (p=0.32). All participants underwent sacrospinous ligament fixation; the rate of concomitant procedures did not differ between study arms. Visual analog scale scores for buttock-specific pain were compared between arms at 1, 3, 6, 12, 24, 36, 48, 72, 96, and 120h postoperatively, and no differences were found.Conclusions Use of long-acting local analgesia at the sacrospinous ligament at the time of sacrospinous ligament fixation does not provide any benefit over short-acting local analgesia.