Bupivacaine for Postoperative Pain After Laparoscopic Hysterectomy

Total laparoscopic hysterectomy (TLH) is widely performed for benign gynecologicconditions and is associated with shorter hospital stay and faster recovery compared withopen surgery. However, postoperative pain remains a relevant clinical concern. Pain afterTLH may originate from abdominal trocar entry sites as well as surgical manipulation andsuturing of the vaginal cuff.Local anesthetic infiltration is a component of multimodal analgesia strategies aimed atreducing postoperative pain and opioid consumption. Bupivacaine, a long‐acting amide‐typelocal anesthetic, has been used for surgical wound infiltration with variable results.While previous studies have evaluated trocar site infiltration alone, limited data areavailable regarding the combined infiltration of both trocar sites and the vaginal cuffin patients undergoing TLH.This study is designed as a prospective, randomized, single‐blind controlled trialconducted at a tertiary referral center. Eligible patients undergoing TLH for benignindications will be randomized into two groups. In the intervention group, a total of 10mL solution containing 5 mL of 0.5% bupivacaine (Marcaine) diluted with 5 mL normalsaline will be administered at the end of surgery. Under laparoscopic visualization, 1 mLof the solution will be injected bilaterally into the sacrouterine ligament regionsadjacent to the vaginal cuff (a total of 2 ml into both sacrouterin ligaments). Aftertrocar removal, the remaining solution will be infiltrated into the trocar entry sitesusing an injector from the subcutaneous tissue down to the fascial layer (approximately 2mL per trocar site). The control group will not receive local anesthetic infiltration.All surgical procedures will be performed using a standardized TLH technique by the samesurgical team.Pain intensity will be assessed using repeated measurements over the first 24postoperative hours. The study will also evaluate recovery‐related parameters and safetyoutcomes. Statistical analysis will be performed using mixed‐effects modeling to accountfor repeated pain measurements over time, with a two‐sided significance level of 0.05.