Background
After vaginal surgery, oral and parenteral narcotics are used commonly for pain relief,
and their use may exacerbate the incidence of sedation, nausea, and vomiting, which
ultimately delays convalescence. Previous studies have demonstrated that rectal analgesia
after surgery results in lower pain scores and less intravenous morphine consumption.
Belladonna and opium rectal suppositories may be used to relieve pain and minimize
side effects; however, their efficacy has not been confirmed.
Objective
We aimed to evaluate the use of belladonna and opium suppositories for pain reduction
in vaginal surgery.
Materials and Methods
A prospective, randomized, double-blind, placebo-controlled trial that used belladonna
and opium suppositories after inpatient or outpatient vaginal surgery was conducted.
Vaginal surgery was defined as (1) vaginal hysterectomy with uterosacral ligament
suspension or (2) posthysterectomy prolapse repair that included uterosacral ligament
suspension and/or colporrhaphy. Belladonna and opium 16A (16.2/60 mg) or placebo suppositories
were administered rectally immediately after surgery and every 8 hours for a total
of 3 doses. Patient-reported pain data were collected with the use of a visual analog
scale (at 2, 4, 12, and 20 hours postoperatively. Opiate use was measured and converted
into parenteral morphine equivalents. The primary outcome was pain, and secondary
outcomes included pain medication, antiemetic medication, and a quality of recovery
questionnaire. Adverse effects were surveyed at 24 hours and 7 days. Concomitant procedures
for urinary incontinence or pelvic organ prolapse did not preclude enrollment.
Results
Ninety women were randomly assigned consecutively at a single institution under the
care of a fellowship-trained surgeon group. Demographics did not differ among the
groups with mean age of 55 years, procedure time of 97 minutes, and prolapse at 51%.
Postoperative pain scores were equivalent among both groups at each time interval.
The belladonna and opium group used a mean of 57 mg morphine compared with 66 mg for
placebo (P=.43) in 24 hours. Patient satisfaction with recovery was similar (P=.59). Antiemetic and ketorolac use were comparable among groups. Subgroup analyses
of patients with prolapse and patients <50 years old did not reveal differences in
pain scores. The use of belladonna and opium suppositories was uncomplicated, and
adverse effects, which included constipation and urinary retention, were similar among
groups.
Conclusion
Belladonna and opium suppositories are safe for use after vaginal surgery. Belladonna
and opium suppositories did not reveal lower pain or substantially lower narcotic
use. Further investigation may be warranted to identify a population that may benefit
optimally from belladonna and opium use.
Key words
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Article Info
Publication History
Published online: December 28, 2016
Accepted:
December 22,
2016
Received in revised form:
November 3,
2016
Received:
August 31,
2016
Footnotes
Supported by Mayo Clinic Arizona.
The authors report no conflict of interest.
Cite this article as: Butler K, Yi J, Wasson M, et al. Randomized controlled trial of postoperative belladonna and opium rectal suppositories in vaginal surgery. Am J Obstet Gynecol 2017;216:491.e1-6.
Identification
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© 2016 Elsevier Inc. All rights reserved.
