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Abstract Symptoms of pelvic floor disease include but are not limited to urine incontinence (UI), faecal incontinence (FI), pelvic organ prolapse (POP), sensory or emptying abnormalities of the lower urinary tract, dysfunctional voiding, sexual dysfunction, and chronic pain syndromes. The term ”pelvic organ prolapse” refers to the herniation of one or more pelvic organs into the vagina (uterovaginal prolapse) or the anal canal (ano-vaginal prolapse) (rectal intussusception and rectal prolapse). Former includes cystocele (bladder prolapse), uterine prolapse, and rectocele (rectal ampulla diverticulum herniating into vagina) or enterocele (intestinal prolapse) as examples of posterior compartment prolapse (a herniation of the small bowel or sigmoid colon into the vagina). As post-pelvic floor repair pain is an important issue in gyncologies. Large amounts of systemic analgesic drugs are often required in the management of intense post-operative pain. After surgery, local anaesthetics have been used either alone or in conjunction with opioids and nonsteroidal antiinflammatory medicines to help with the pain. Conduction anaesthesia can be used to effectively numb nearly any area of the body. Nonetheless, only a handful of methods get regular clinical application. In order s Summary - 89 - to ensure the safety, comfort, and efficiency of the patient during surgery, general anaesthetic or sedation is sometimes used in conjunction with conduction anaesthesia. Conduction anaesthesia is useful for a variety of surgical procedures, including those intended to repair the pelvic floor. High doses of opiates given systemically have been linked to adverse effects such itching, nausea, vomiting, drowsiness, and decreased breathing. After pelvic floor restoration, discomfort can be managed with the help of local anaesthetic infiltration. Benefits of local infiltration may include better patient compliance, convenience, comfort, and constant analgesia because the medication does not have to undergo first-pass hepatic metabolism. Oftentimes, after a pelvic floor repair, the patient would want to stay awake and not on too many drugs. After spinal anaesthesia, the longest acting local anaesthetics (bupivacaine) only provide pain relief for 4-8 hours. Bubivacain has local anesthetic effect. The aim of the study was to compare between Bubivacain and placebo in local infiltration on post pelvic floor repair pain relief regarding the total amount of analgesic consumption, first time request analgesia and complications. Summary - 90 - Sixty women who had pelvic floor repair under spinal anesthesia were randomized into two groups according to the local anesthetic drug used: group A: 30 patients infiltrated by 30 ml of 0.5 % bupivacaine hydrchloride in posterior vaginal wall, perineal body and site of incision. group B: 30 patients infiltrated by 30 ml of 0.9 % normal saline (placebo) in posterior vaginal wall, perineal body and site of incision. Patients received post-operative analgesia in form of IV paracetamol according to visual analogue scale value, pain assessed 2h after operation using a 100 point visual analogue scale (VAS) which was continued in the ward at 2, 4, 8 and 24 hours post-operatively during rest and on coughing, first time to request analgesia, the amount of analgesic consumed after 24 hrs, side effects and complication were recorded. The presented study revealed that: There was no statistical difference in age, height, number of pregnancies, number of births, or operation time between the two groups. However, there was a statistically significant difference in weight (p = 0.013) and body mass index (p = 0.010). Summary - 91 - Bupivacaine infiltration of the surgical site following spinal anaesthetic reduced discomfort compared to placebo. Resting and coughing Visual Analogue scale readings differed significantly. Local anaesthetic reduced resting pain intensity at 2 h, 4 h, and 8 h (p=0.000, 0.028, and 0.021, respectively). The median pain intensity during coughing was considerably lower for the local anaesthetic group at 2 h (p=0.000) and 4 h (p=0.031), but after 24 h there was no statistically significant difference in pain intensity at rest (p=0.962) or during coughing (p=0.763). Women of the local anesthesia group had significantly lower odds of having moderate/severe pain intensity at 2h(p=0.020), 4h(p=0.024) and 8h(p=0.045) at rest and at 2h(p=0.028), 4h(p=0.035) during coughing postoperatively, however, by 24 h, there was no statistical difference in the percentage of patients reporting moderate/severe pain at rest and during coughing . Neither group experienced significantly different adverse events from the other (nausea and vomiting). Nausea and vomiting occurred in 2-4% (6-13%) of bupivacaine patients compared to 3-8% (3-20%) of placebo patients. The percentage of patients Summary - 92 - experiencing nausea and/or vomiting did not differ significantly between the groups (all p > 0.05). The Analgesics consumption was highly significantly lower in the local anesthesia group at 4 h with Mean ± SD (3.39 ± 1.24, 6.80 ± 2.22) and 8 h with Mean ± SD (3.42 ± 1.00, 6.58 ± 2.04), p value (0, 000) postoperatively than placebo group. The percentage of patients who used an analgesic did not vary significantly (all p > 0.05) |