Preventive analgesia aims to minimize sensitization and pain caused by perioperative noxious stimuli. Despite the critical issue of postoperative pain in transvaginal pelvic reconstructive surgeries, there are currently no specific guidelines for a standard preventive analgesia scheme in this context. This study aims to evaluate the effectiveness of preventive analgesia in reducing postoperative pain after transvaginal pelvic reconstructive surgeries.

We conducted a comprehensive search of PubMed, EMBASE, Ovid, and Cochrane Library from inception to June 19, 2023. The inclusion criteria encompassed randomized trials assessing the Visual Analog Scale (VAS) within 24 hours post-operation and the total postoperative opioids consumption in various types of transvaginal reconstructive surgeries excluding hysterectomy. To evaluate biases, we utilized the Revised Cochrane risk-of-bias tool for randomized trials. 
The Bayesian inference based on Markov Chain Monte Carlo methods are more robust with small sample sizes and could be exploited to address the uncertain detection bias with expert-adjusted prior distributions. Therefore, we applied Bayesian meta-analysis with random effects model to assess the standard mean difference (SMD) of cumulated VAS until post operative day 1 (cVAS POD-1) as the primary outcome. The secondary outcome was the amount of total postoperative opioids consumption (POC, measured by milligram).

A total of 10 studies involving 843 participants were included, with 425 in the preventive analgesia group and 418 in the control group. Preventive analgesia primarily entailed the local administration of lidocaine or bupivacaine around the pelvic surgical incision, covering procedures such as mid-urethral sling, sacrospinous ligament colpopexy, and posterior colporrhaphy. The SMD of cVAS POD-1 between the two groups was -0.15 (95% CrI: -0.40 to 0.10), with the exact probability of being lower than zero calculated from the posterior distribution, i.e., P(SMD<0) = 90.15%. The SMD of POC was -0.28 (95% CrI: -0.54 ~ -0.06), with P(SMD<0) = 99.13%.

Despite the implementation of preventive analgesia, there was not a clinically significant reduction in postoperative pain levels following transvaginal pelvic reconstructive surgeries, as indicated by the minimal effect size observed in cVAS POD-1. However, it did contribute to a small to moderate reduction in postoperative opioid consumption, suggesting a potential benefit in reducing opioid use in this patient population.

The findings suggest that while preventive analgesia may not substantially alleviate postoperative pain, it could play a role in reducing opioid consumption following transvaginal pelvic reconstructive surgeries. Further research is warranted to explore additional strategies or interventions that may effectively address postoperative pain in this patient population.

Continence 12S (2024) 101580
DOI: 10.1016/j.cont.2024.101580