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To Pack or Not to Pack? A Randomized Trial of Vaginal Packing After Vaginal Reconstructive Surgery

Westermann, Lauren B. DO; Crisp, Catrina C. MD, MSc; Oakley, Susan H. MD; Mazloomdoost, Donna MD; Kleeman, Steven D. MD; Benbouajili, Janine M. MA; Ghodsi, Vivian RN; Pauls, Rachel N. MD

Female Pelvic Medicine & Reconstructive Surgery: March/April 2016 - Volume 22 - Issue 2 - p 111–117
doi: 10.1097/SPV.0000000000000238
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Objective Placement of vaginal packing after pelvic reconstructive surgery is common; however, little evidence exists to support the practice. Furthermore, patients have reported discomfort from the packs. We describe pain and satisfaction in women treated with and without vaginal packing.

Methods This institutional review board–approved randomized-controlled trial enrolled patients undergoing vaginal hysterectomy with prolapse repairs. The primary outcome was visual analog scales (VASs) for pain on postoperative day 1. Allocation to “packing” (“P”) or “no-packing” (“NP”) arms occurred intraoperatively at the end of surgery. Visual analog scales regarding pain and satisfaction were completed early on postoperative day 1 before packing removal. Visual analog scale scores for pain, satisfaction, and bother attributable to packing were recorded before discharge. All packing and perineal pads were weighed to calculate a “postoperative vaginal blood loss.” Perioperative data were collected from the hospital record. Our sample size estimation required 74 subjects.

Results Ninety-three women were enrolled. After exclusions, 77 were randomized (P, 37; NP, 40). No differences were found in surgical information, hemoglobin levels, or narcotic use between groups. However, “postoperative vaginal blood loss” was greater in packed subjects (P < 0.001). Visual analog scale scores for pain before removal of packing (P, 41.6 vs NP, 46.3; P = 0.43] and before discharge (P, 35.0 vs NP, 40.0; P = 0.43] were not significantly different between treatment arms. Likewise, VAS scores for satisfaction before removal of packing (P, 81.0 vs NP, 90.0; P = 0.08] and before discharge (P, 90.0 vs NP, 90.5; P = 0.60] were not significantly different. Packed patients noted lower nursing verbal pain scores (P = 0.04) and used less ketorolac (P = 0.01). Bother from packing was low overall.

Conclusions Although there was no difference based on VAS, women receiving vaginal packing had lower nursing documented pain and used less ketorolac than packed women. Vaginal packing may provide benefit and can remain part of the surgical practice.

Women undergoing hysterectomy with prolapse repair receiving vaginal packing noted similar VAS scores for pain and satisfaction as those not receiving packing.

From the *Division of Urogynecology, Department of Obstetrics and Gynecology, and †Hatton Research Institute, TriHealth Good Samaritan Hospital, Cincinnati, OH.

Reprints: Lauren B. Westermann, DO, Women's Center for Specialized Care, TriHealth Good Samaritan Hospital, 3219 Clifton Ave, Suite 100, Cincinnati, OH 45220. E-mail: Lauren_westermann@trihealth.com.

Supported by the TriHealth Hatton Institute Medical Education Research Fund.

Presented orally and received President's Award for Resident/Fellow First Prize Paper at Society for Gynecologic Surgeons 41st Annual Scientific Meeting, March 2015.

The authors have declared they have no conflicts of interest.

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