The effect of a paracervical block prior to total laparoscopic hysterectomy on patient's quality of recovery.

INTERVENTION: The intervention group will receive 20mL of bupivacaine 0.5% with 1:200,000 adrenaline infiltrated via paracervical block, after induction of general anaesthesia and prior to the initial surgical incision. The intervention is TGA approved. Five millilitres of the solution will be injected at the 3, 5, 7, and 9 o’clock positions of the cervicovaginal junction at a depth of 10mm as described in the 7th edition of Te Linde’s Operative Gynecology. The injection will be prepared at the hospital pharmacy. The Study Coordinator will deliver this to the surgeon in theatre. A copy of the randomisation sheet documenting the drug administered will be filed in the patients medical records. The surgeon, patient and anaesthetist will not be aware of which preparation is used. CONDITION: Anaesthesiology ‐ Pain management Post operative pain;Hysterectomy; ; Post operative pain ; Hysterectomy Reproductive Health and Childbirth ‐ Other reproductive health and childbirth disorders Surgery ‐ Other surgery PRIMARY OUTCOME: Completion of Quality of recovery questionnaire (QoR‐15) to measure patient reported quality of recovery.[Measured 24‐36 hours post operatively] SECONDARY OUTCOME: Assessing Length of Hospitalisation by accessing patient medical records ; [At the time of hospital discharge ; ] Completion of Quality of recovery questionnaire (QoR‐15) to measure patient reported quality of recovery.[measured 7 days post surgery.] Composite opioid measured by accessing patient medical records[Measured up to 24 hours post surgery] Nausea and Vomiting[Assessed by requirement for anti‐emetics, which will be determined by accessing patient medical records. Antiemetic use will be documented for the first 24 hours post surgery.] Opioid use in Post Anesthesia Care Unit by accessing patient medical records. ; [Period whilst in Post Anesthesia Care Unit ; ] Pain score utilising visual analogue scale at rest [Measured at a single set timepoint between 24‐36 hours post surgery. ; ] Pain score utilising visual analogue scale at rest [Measured at day 7 post operatively] Pain score utilising visual analogue scale at time of mobilisation [Measured at a single timepoint between 24‐36 hours post surgery. ; ] Pain score utilising visual analogue scale at time of mobilisation [Measured at day 7 post operatively] Time in Post Anesthesia Care Unit by accessing patient medical records. ; [Timepoint: from surgery finish time to time returned to ward ; ] Time to mobilisation after surgery by accessing patient medical records. ; [Measured up to 36 hours post surgery ; ] INCLUSION CRITERIA: 1. Women undergoing a total laparoscopic hysterectomy (TLH) plus or mimus bilateral Salpingo‐oophorectomy (BSO) for any of the following conditions: a. Heavy menstrual bleeding/ abnormal uterine bleeding b. Stage 1 and 2 Endometriosis c. Adenomyosis d. Risk reduction surgery e.g. carriers of BRCA1/2 gene faults, Lynch Syndrome or women considered high risk due to family history e. Complex adnexal masses not suspicious for malignancy f. Early stage cervical cancer requiring simple hysterectomy 2. Patients aged 18 years of age and over 3. Fluent in English