• Steven Radtke, Todd Boren, and Stephen Depasquale.
• Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, Tennessee (all authors). Electronic address: dr.radtke@gmail.com.
• J Minim Invasive Gynecol. 2019 Sep 1; 26 (6): 1164-1168.

Study ObjectiveTo determine if performing a paracervical block with .5% bupivacaine before laparoscopic hysterectomy reduces postoperative pain.DesignDouble-blind randomized controlled trial (Canadian Task Force classification I).SettingUniversity-affiliated hospital.PatientsWomen aged between 18 and 65 years scheduled to undergo total laparoscopic hysterectomy for benign indications.InterventionsEligible patients were allocated to control or treatment groups using block randomization. Surgeon administered injection of either .9% NaCl or .5% bupivacaine into the cervical stroma at the 3 and 9 o'clock positions after general anesthesia was established. Pain was assessed using a visual analog scale with a range from 0 to 10 at 30 and 60 minutes after extubation.Measurements And Main ResultsForty-one patients met criteria for analysis. Based on randomization, 20 were allocated to the control arm and 21 to the treatment arm. We used Student t and Pearson χ2 tests to ensure both groups were homogenous to age (46.5 vs 46, p = .87), body mass index (35 vs 32.7 kg/m2, p = .45), minutes of operating time (132.5 vs 119.7, p = .11), specimen weight (138.8 vs 160.6 g, p = .44), and history of cesarean section (p = .58). Pain scores at 30 minutes (5.7 vs 3.2, p = .01) and 60 minutes (5.9 vs 2.3, p <.001) were significantly lower in the treatment arm. We dichotomized results depending on whether patients had successful postoperative pain control, defined as an average pain score of 4 or less. The χ2 test was used for comparison. Using this definition 25% of patients had successful pain control in the placebo group versus 71.4% in the treatment group. This was statistically significant (p = .003). Mean length of hospital stay (.65 vs .86 days, p = .44) was not statistically different.ConclusionPerforming a paracervical block with .5% bupivacaine before laparoscopic hysterectomy significantly reduces immediate postoperative pain. (ClinicalTrials.gov no.: NCT03027661.).Copyright © 2019. Published by Elsevier Inc.

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