الفهرس 
PELVIC FLOOR DYSFUNCTIONOnly 14 pages are availabe for public view
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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
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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.
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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).
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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
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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)