Paracervical Block for Immediate Postoperative Pain Prevention after Total Laparoscopic Hysterectomy: A Double-Blind, Placebo-Controlled Randomized Trial

Objective: This study sought to determine if paracervical block with 0.5% bupivacaine reduces immediate postoperative pain as a mode of preemptive analgesia in total laparoscopic hysterectomy (TLH). Materials and Methods: This double-blind, placebo-controlled randomized trial was conducted at a tertiary care teaching institute over a period of 2 years. Women undergoing TLH for benign pathologies were included and randomized to the intervention group (received paracervical block with 0.5% bupivacaine) or placebo group (received paracervical block with normal saline). Postoperative pain scores were assessed at 30 and 60 minutes from the extubation time along with additional analgesia requirement, time to first mobilization, and duration of hospital stay. Results: A total of 154 women were randomized; six women were excluded from the analysis after conversion to open surgery or dense adhesiolysis. The remaining 148 women comprised the study population (74 in each group). We found no differences in the groups with regard to basic demographics and surgical characteristics. A significant reduction was found in pain scores in the intervention group ( p = 0.011 at 30 minutes and p = 0.019 at 60 minutes). There was no difference in the need for additional analgesia, time to first mobilization, and duration of hospital stay between the two groups. Conclusion: Paracervical block is an effective mode of preemptive analgesia in TLH.