Background
The incidence of temporary gluteal pain after sacrospinous ligament colpopexy ranges
from 6.1% to 15.3%. Gluteal pain may occur as a result of injury to S3 to S5 nerve
roots that course over the mid-portion of the coccygeus-sacrospinous ligament complex
at the time of suspension suture placement. There are no data on the use of injections
to prevent postoperative pain from nerve entrapment at the time of suture placement.
Objective
The purpose of this study was to determine whether intraoperative local analgesia
that is administered at the level of the sacrospinous ligament can lessen the gluteal
pain felt by patients postoperatively after sacrospinous ligament colpopexy.
Study Design
In a randomized double-blind placebo-controlled trial, women with vaginal apex prolapse
who were undergoing surgical treatment with sacrospinous ligament colpopexy underwent
intraoperative injection with either 0.25% bupivacaine or normal saline solution.
Subjects completed visual analog pain scales (0–10) and the Activities Assessment
Scale and recorded the use of pain medications over a 6-week period. The primary outcome
was postoperative gluteal pain. A sample size of 50 subjects (25 in each arm) was
planned to test the hypothesis that local analgesia administration will lessen postoperative
pain compared with placebo.
Results
Between April 2014 and March 2016, 51 women were enrolled in the study, and 46 women
underwent sacrospinous ligament colpopexy. On postoperative day 1, 90.2% of all subjects
(n=41) reported gluteal pain. At weeks 1 and 2, 63.8% (n=29) and 44.1% (n=20) women
reported pain; at weeks 4 and 6, 33.3% (n=15) and 26.9% (n=12) women continued to
have some pain. On day 1, the mean score for gluteal pain was 3.7±2.9. By week 1,
the score was 1.8±2.6; by week 6, the mean score was 0.1±0.3. There were no differences
in pain scores for patients who had undergone injection with 0.25% bupivacaine and
those who were injected with normal saline solution. Patients in the placebo group
used significantly more nonsteroidal antiinflammatory drugs than the treatment group:
adjusted odds ratio, 1.25; 95% confidence interval, 1.04–1.35; P=.01). By 6 weeks, 87.5% of patients had returned to their baseline “light” activity
level. There was no difference in time to return to baseline between the groups.
Conclusion
Intraoperative administration of local analgesia does not reduce patients’ perceptions
of postoperative gluteal pain after sacrospinous ligament colpopexy; however, it may
reduce the need for pain medication after surgery.
Key words
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Article Info
Publication History
Published online: March 31, 2018
Accepted:
March 26,
2018
Received in revised form:
March 22,
2018
Received:
November 1,
2017
Footnotes
Clinical Trial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02037061.
The authors report the following disclosures: Mark Walters - receives royalties from Elsevier, Inc. and UpToDate, Inc.; consultant for Coloplast, Inc. Cecile Ferrando - receives roylaties from UpToDate, Inc.
Cite this article as: Ferrando CA, Walters MD. A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy. Am J Obstet Gynecol 2018;218:599.e1-8.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
