Effect of Paracervical Block on Post Operative Pain in Laparoscopic Gynecologic Surgery

• Hospital admission for postoperative pain control [ Time Frame: Four hours after conclusion of surgery ] [ Designated as safety issue: No ]
  

• Postoperative pain score [ Time Frame: 1 hour postoperatively ] [ Designated as safety issue: No ]
  Postoperative pain levels will be assessed using the visual analogue pain scale. This scale pairs faces with numbers 1-10, with 1 being no pain and 10 being extreme pain. In the PACU pain will be assessed using this scale by the nursing staff. On postoperative days 1 and 2 the subjects will self-report their pain level.
  
  
• Postoperative pain score [ Time Frame: 2 hours postoperatively ] [ Designated as safety issue: No ]
  Postoperative pain levels will be assessed using the visual analogue pain scale. This scale pairs faces with numbers 1-10, with 1 being no pain and 10 being extreme pain. In the PACU pain will be assessed using this scale by the nursing staff. On postoperative days 1 and 2 the subjects will self-report their pain level.
  
  
• Postoperative pain score [ Time Frame: 4 hours postoperatively ] [ Designated as safety issue: No ]
  Postoperative pain levels will be assessed using the visual analogue pain scale. This scale pairs faces with numbers 1-10, with 1 being no pain and 10 being extreme pain. In the PACU pain will be assessed using this scale by the nursing staff. On postoperative days 1 and 2 the subjects will self-report their pain level.
  
  
• Postoperative pain score [ Time Frame: 1 day postoperatively ] [ Designated as safety issue: No ]
  Postoperative pain levels will be assessed using the visual analogue pain scale. This scale pairs faces with numbers 1-10, with 1 being no pain and 10 being extreme pain. In the PACU pain will be assessed using this scale by the nursing staff. On postoperative days 1 and 2 the subjects will self-report their pain level.
  
  
• Postoperative pain score [ Time Frame: 2 days postoperatively ] [ Designated as safety issue: No ]
  Postoperative pain levels will be assessed using the visual analogue pain scale. This scale pairs faces with numbers 1-10, with 1 being no pain and 10 being extreme pain. In the PACU pain will be assessed using this scale by the nursing staff. On postoperative days 1 and 2 the subjects will self-report their pain level.
  
  
• Postoperative pain medication use [ Time Frame: Postoperative days 0-14 ] [ Designated as safety issue: No ]
  Type and amount of pain medication by each subject will be recorded in the PACU postoperatively. The subjects then record at home the type and amount of pain medication they use for 14 days postoperatively.
  
  

A variety of traditionally open surgical procedures have recently become minimally invasive through the use of laparoscopic technology. Gynecologic surgeries are no exception. However, some gynecologic laparoscopic procedures are associated with significant post-operative pain, necessitating prolonged hospitalization, use of post-operative opioids, and in some cases, the development of chronic post-operative pain. Prolonged hospitalization and use of opioids pose important patient safety concerns, such as increased risk of hospital borne illnesses and medication errors; in addition, opioids may cause respiratory depression and addiction. Given the rising cost of health care there is also an economic incentive to eliminate the need for hospital admission due to post-operative pain.

Preemptive analgesia involves nerve blockade or administration of pain medication systemically prior to incision to reduce post-procedure pain. Paracervical blockade is a form of preemptive analgesia. Paracervical blocks have been demonstrated to be safe and effective for obstetrical procedures in reducing post-operative pain since the 1970s. Recently they have also been shown to be efficacious for reducing post-operative pain in vaginal hysterectomy (Long et al, Int Urogynecol J (2009) 20:5—10).

For the present investigation, we intend to study the effectiveness of paracervical blockade for laparoscopic and robotic-assisted laparoscopic gynecological surgery. We hypothesize that paracervical blockade prior to surgical incision will lessen levels of post-operative pain, reduce use of opioids, and decrease the number of patients requiring hospitalization for pain control. We also hypothesize that the effects may be longer lasting than the immediate post-operative period and may decrease the amount of time to return to normal activity after surgery.

Using anecdotal evidence from the primary investigator, Dr. Ascher-Walsh the rate of hospitalization for laparoscopic hysterectomy (laparoscopic-assisted vaginal hysterectomy, total laparoscopic hysterectomy, laparoscopic assisted supracervical hysterectomy) is approximately 67%. In this study, we wish to decrease hospitalization with the paracervical block by 50%, thus obtaining an overall post-operative hospitalization rate of 33%. For robotic-assisted laparoscopic myomectomy, the rate of hospitalization is 50%. We wish to decrease this by 50% as well. Overall we are aiming to achieve a rate of 30% for post-operative hospitalization for pain control for laparoscopic hysterectomies and robotic myomectomies combined.