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A Randomized Comparison of Bupivacaine Versus Saline During Placement of Tension-Free Vaginal Tape

Bracken, Jessica N. MD*; Huffaker, R. Keith MD; Yandell, Paul M. MD*; Handcock, Tyler MD; Higgins, Edmund W. MD§; Kuehl, Thomas J. PhD*; Shull, Bobby L. MD*

Female Pelvic Medicine & Reconstructive Surgery: March/April 2012 - Volume 18 - Issue 2 - p 93–96
doi: 10.1097/SPV.0b013e3182436655
Original Articles

Objectives: To compare postoperative urinary retention and pain control when bupivacaine versus saline for hydrodissection is used while placing tension-free vaginal tape midurethral slings.

Methods: A prospective, randomized, double-blind trial was performed after institutional review board approval. Sixty women were randomized to receive bupivacaine or saline for hydrodissection. Subjects and research team were blinded to subject assignments. Group characteristics were compared using the Student t test, the χ2 test, and the Mann-Whitney U test. Proportions of subjects with a successful postoperative voiding trial along with measurements of postoperative pain and analgesic use were compared using similar appropriate tests. The study was powered to detect differences in voiding trial success from an estimated 58% to greater than 90% with P < 0.05 and 0.8 power using 25 subjects per group.

Results: Thirty patients were allocated to each group. One subject in the saline-only group was excluded. Group characteristics were not different. After surgery, pain medication use (20/30 vs 25/29 for bupivacaine vs saline only; P = 0.08), pain scores (36 ± 22 vs 31 ± 24; P = 0.49), and successful voiding trials did not differ (14/30 vs 19/29; P = 0.14), whereas postvoid residuals did differ (225 ± 180 mL vs 140 ± 147 mL; P = 0.043).

Conclusions: Bupivacaine was not seen to improve immediate postoperative pain after placement of a tension-free vaginal tape. It did not increase the risk of failing a postoperative voiding trial. Without an obvious benefit, the use of an additional medicine is not supported. We suggest saline alone be used for hydrodissection.

Bupivacaine did not increase the risk of failing a postoperative voiding trial nor reduce postoperative pain levels in a randomized comparison of Bupivacaine versus saline for hydrodissection during placement of TVT, suggesting saline alone be preferred.

From the *Department of Obstetrics and Gynecology, Scott & White Healthcare, and the Texas A&M University System Health Science Center College of Medicine, Temple, TX; †Quillen ETSU Pelvic Surgery and Urogynecology, Department of Obstetrics and Gynecology, East Tennessee State University Quillen College of Medicine, Johnson City, TN; ‡Department of Obstetrics and Gynecology, Round Rock Scott & White Hospital and Clinic at Round Rock, Round Rock, TX; and §Division of Urogynecology, Department of Obstetrics and Gynecology, Womack Army Medical Center, Fort Bragg, NC.

Reprints: Thomas J. Kuehl, PhD, Department of Obstetrics and Gynecology, Scott & White Healthcare, 2401 S 31st St, Temple, TX 76508. E-mail: tkuehl@swmail.sw.org.

Disclaimer: The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

Funding for this study was provided by the Enderly Endowment for Research in Urogynecology and the Noble Centennial Endowment (TJK).

The authors declare that they have nothing to disclose.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins