Perineoplasty and Postoperative Pain Scores Following Vaginal Prolapse Repairs

Objectives: To examine the effect of perineoplasty on acute postoperative pain following total vaginal hysterectomy (TVH) with prolapse repairs.

Methods: We conducted a retrospective cohort study on patients who underwent TVH and prolapse repairs with or without perineoplasty from 2014-2023 at a safety-net hospital. Acute postoperative pain in the post-anesthesia care unit (PACU) was assessed using a visual analogue scale of 0 to 10 (10 being the most severe pain) immediately postoperatively and at time of discharge prior to leaving the PACU. Pain scores were averaged for each patient. A univariate analysis was performed using the Mann-Whitney U test shown in Table 1. Multivariate regression analysis was employed to assess the relationship between perineoplasty and postoperative pain scores, controlling for potentially relevant confounding factors.

Results: Of the 610 individuals with postoperative pain scores available, 213 (35%) underwent perineoplasty. Average age was 54.7 (10.6) and average body mass index (BMI) was 30.5 (5.8). In individuals that underwent perineoplasty, the median pain score (IQR) was 6 (3 to 8) compared to 7 (5 to 9) in those without perineoplasty (p=0.002). After adjusting for age, BMI, menopausal status, anterior colporrhaphy, posterior colporrhaphy, mid-urethral sling, intraoperative use of liposomal bupivacaine, total operative time, and estimated blood loss, individuals that underwent a perineoplasty had a similar level of postoperative pain when compared to those that did not. In the multivariate analysis, increasing age was noted to have significantly decreased postoperative pain scores.

Conclusions: In this study, we found that perineoplasty at the time of TVH with prolapse repairs was not associated with differences in immediate postoperative pain scores. However, we cannot make conclusions about differences in postoperative pain levels at other time points during the recovery period. The use of liposomal bupivacaine, chronic pain syndrome, and total operative time were approaching statistical significance and can be considered as effect modifiers in future studies.