{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T17:28:10Z","timestamp":1773163690308,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare local anaesthetic with adrenaline (LAA) with normal saline for hydrodissection at vaginal hysterectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A double\u2010blind, two parallel group multicentre randomised controlled trial (RCT) was planned.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>217 women undergoing vaginal hysterectomy were screened in the five participating centres between March 2015 and December 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>156 patients were recruited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were randomised to Bupivacaine 0.25%\/0.5% with adrenaline 1:200000 vesus normal saline. They completed baseline \u2018pre\u2010operation\u2019, \u2018same day 3\u20136\u2009h post\u2010op\u2019 and \u2018morning after surgery\u2019 short\u2010form McGill pain questionnaire (SFMcGill).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Primary endpoint was post\u2010operative pain measured using SFMcGill. Secondary endpoints included estimated blood loss (EBL), ease of dissection, severity of ooze, change in pre\u2010 and post\u2010operative haemoglobin, operating time, duration of inpatient stay and incidence of post\u2010operative morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no demographic differences between the groups. LAA was associated with significantly smaller increases in pain scores compared to placebo, both between pre\u2010operative and same\u2010day post\u2010operative (7.105 <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and to the next day post\u2010operative (1.334 <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><jats:p>Use of placebo infiltrate was associated with increased intra\u2010operative bleeding (difference in EBL 110\u2009mL <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), increased severity of ooze (VAS difference 5.01 <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and more difficult dissection (VAS difference 2.96 <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). There were no differences in pre\u2010operative or post\u2010operative measures of Hb, PCV, or post\u2010operative analgesia (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). There were significantly more complications in the placebo arm (5 vs. 0, <jats:italic>p<\/jats:italic>\u2009=\u20090.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This multicentre\u2010RCT demonstrated the value of LAA compared to normal saline as a paracervical infiltrate during vaginal hysterectomy under general anaesthesia: reduced intra\u2010operative blood loss, improved ease of dissection, decreased same and next day pain scores and complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.18162","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T03:41:43Z","timestamp":1745379703000},"page":"1212-1219","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Post\u2010Operative Pain After Pelvic Organ Prolapse Surgery (POPPOP): A Double Blind Randomised Multicentre Study to Assess the Effect of Local Anaesthesia During Vaginal 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