Prospective evaluation of combined local bupivacaine and steroid injections for the management of chronic vaginal and perineal pain.
Summary of "Prospective evaluation of combined local bupivacaine and steroid injections for the management of chronic vaginal and perineal pain."
PURPOSE:
Vaginal/perineal pain is common following obstetric trauma or vaginal surgery for prolapse and may have a serious impact on sexual function and quality of life. Local injections of corticosteroids, local anaesthetic and hyaluronidase are treatment options for chronic pain; however, there are no published studies to support their efficacy. The objective of this study was to evaluate prospectively the efficacy of perineal/vaginal injections for chronic localised pain following childbirth or vaginal surgery.
METHODS:
Consecutive women with chronic vaginal/perineal pain were recruited in this prospective series (audit). Pain severity and sexual function were determined using a visual analogue scale (VAS 0-10) and the abbreviated sexual function questionnaire (ASFQ) respectively. Patients underwent local injections with a combination of 0.5% bupivacaine (10 ml), hydrocortisone (100 mg) and hyaluronidase (1,500 IU). Follow-up was undertaken at four-weekly intervals. Further injections were performed as clinically indicated.
RESULTS:
Fifty-three women underwent ≥1 injections [mean: 1.86 (range: 1-4)]. Mean interval from index childbirth [43/53 (81%)] or surgical intervention [10/53 (19%)] was 8 months (range 12 weeks-20 years). Twenty-seven women (51%) were sexually active. All reported dyspareunia. Fifteen (28%) women required 1 and 31(59%) two injections. Pre treatment VAS pain scores were 6.1 versus 4.1 after first injection (p = 0.0002, 95% CI 1.01-3.05) and mean ASFQ scores increased from 18.1 to 29.1 (p = 0.01, 95% CI -17.2 to -2.3) 4 weeks post-injection. There were no adverse events or morbidity. 24/27 (89%) sexually active women with dyspareunia resolved and 18/26 (69%) sexually inactive women resumed satisfactory sexual activity 8 weeks post-injection.
CONCLUSION:
In our series, this treatment was well tolerated and significant improvements in pain scores and sexual function were observed.
Affiliation
Department of Pelvic Reconstructive Surgery and Urogynaecology, St George's Hospital, 4th Floor Lanesborough Wing, Blackshaw Road, London, SW17 0QT, UK, sdoum@yahoo.com.
Journal Details
This article was published in the following journal.
Name: Archives of gynecology and obstetrics
ISSN: 1432-0711
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21079978
- DOI: http://dx.doi.org/10.1007/s00404-010-1763-z
Medical and Biotech [MESH] Definitions
Bupivacaine
A widely used local anesthetic agent.
Etidocaine
A local anesthetic with rapid onset and long action, similar to BUPIVACAINE.
Lidocaine
A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine.
Prospective Payment Assessment Commission
The commission charged with evaluating issues and factors which affect the implementation of the PROSPECTIVE PAYMENT SYSTEM.
Mepivacaine
A local anesthetic that is chemically related to BUPIVACAINE but pharmacologically related to LIDOCAINE. It is indicated for infiltration, nerve block, and epidural anesthesia. Mepivacaine is effective topically only in large doses and therefore should not be used by this route. (From AMA Drug Evaluations, 1994, p168)
PubMed Articles
Pulmonary embolism in soldiers serving at high altitude.
Objective: To compare whether an individual could appreciate the pain relief, if any, in either one of his/her tonsillar fossa topically suffused with a local anaesthetic (bupivacaine). Study Design:...
This randomized, active-controlled study evaluated the extent and duration of analgesia after administration of liposome bupivacaine (LB), a novel formulation of bupivacaine, compared with bupivacaine...
Steroids in regional analgesia.
Importance of the field: Local injections of steroids have been widely practiced to provide regional analgesia for the treatment of a wide variety of musculoskeletal pain syndromes. However, evidence...
Technique for CT Fluoroscopy-Guided Cervical Interlaminar Steroid Injections.
OBJECTIVE: We describe the use of CT fluoroscopy as a guidance tool for performing interlaminar epidural steroid injections in the cervical spine. CONCLUSION: CT fluoroscopy is an alternative method t...
PURPOSE: Bupivacaine-induced myotoxicity is associated with mitochondrial bioenergetic alterations. The impact of the duration of bupivacaine treatment on mitochondrial energy production remains undet...
Clinical Trials
Bupivacaine Effectiveness and Safety in SABER™ Trial
This is a research study testing SABER™-Bupivacaine (an experimental pain-relieving medication). SABER™-Bupivacaine is designed to continuously deliver bupivacaine, a common local ane...
A Safety and Efficacy Study of SABER™-Bupivacaine for Pain Following Hernia Repair
This is a research study testing SABER™-Bupivacaine (an experimental pain-relieving medication). SABER™-Bupivacaine is designed to continuously deliver bupivacaine, a common local an...
Epidural Study of Patients With Chronic Lower Back Pain
The purpose of this study is to examine 4 different epidural dosing regimes of local anaesthetic solution in a series of 3 epidural injections over a period of 12 months to determine the o...
A Safety and Effectiveness Study of SABER™-Bupivacaine for Pain Following Shoulder Surgery
This is a research study testing SABER™-Bupivacaine (an experimental pain-relieving medication). SABER™-Bupivacaine is designed to continuously deliver bupivacaine, a common local ane...
Spinal Anesthesia for Cesarean Delivery: Bupivacaine With or Without Fentanyl
The safest form of anesthesia for Cesarean section is a spinal anesthetic. All spinal anesthetics contain a local anesthetic and/or a narcotic. A drug named bupivacaine is the most commo...
