The Role of Vaginal Cuff Exparel Injection in Enhancing Postoperative Analgesia Following Hysterectomy [ID 3470]

INTRODUCTION: To evaluate whether adjunctive vaginal cuff infiltration with liposomal bupivacaine (Exparel) improves postoperative pain control and recovery in patients undergoing robotic-assisted laparoscopic hysterectomy (RALH). METHODS: This was a retrospective cohort study of women undergoing RALH for benign indications at two academic tertiary care centers between January and November 2024. The intervention consisted of a standardized anesthetic mixture prepared with 20 mL of Exparel, 40 mL of 0.25% bupivacaine, and 100 mL of normal saline. All patients received bilateral quadratus lumborum (QL) blocks with 70 mL administered per side. In the study group, an additional 20 mL was injected into the vaginal cuff following closure; the control group received no cuff injection. Demographic characteristics, postoperative pain scores (visual analog scale), opioid consumption, hospital length of stay, and complications were recorded. RESULTS: Forty-four women were included (22 per group). Age, body mass index, parity, and uterine weight were comparable (436 g [interquartile range (IQR) 330–634] versus 390 g [IQR 213–860]; P =.42). Median VAS pain scores prior to discharge were low and not significantly different (2 [IQR 0–3] versus 1 [IQR 0–2]; P =.26). On postoperative day 1, scores remained similar (4 [IQR 2–6] versus 3 [IQR 2–6]; P =.86). A nonsignificant trend toward reduced opioid use was observed in the study group ( P =.07). CONCLUSIONS/IMPLICATIONS: Vaginal cuff Exparel infiltration combined with QL block is feasible and well tolerated in RALH. Although pain scores were not significantly different, the trend toward lower opioid requirements suggests potential clinical benefit. Larger prospective trials are warranted.