94 posters,  16 sessions,  61 topics,  91 authors 
ePostersLive® by SciGen® Technologies S.A. All rights reserved.

A1-5
Comparing outcomes following pelvic floor reconstructive surgery for the use of vaginal packing soaked with either estrogen, bupivacaine or saline

Poster Presenter
Affiliations

Rate

No votes yet

Comparing outcomes following pelvic floor reconstructive surgery for the use of vaginal packing soaked with either estrogen, bupivacaine or saline

Background:

It is standard practice to place gauze packing in the vagina at the end of a vaginal procedure to prevent post-surgical vaginal bleeding.
The traditional regimen is to fill the vaginal cavity with the packing and remove it the morning of post-operative day 1 (POD#1). 
The origin and rationale for this practice is unclear.
Theoretical benefits include reduction in: blood loss, pelvic fluid accumulation, hematoma formation, and post-operative adhesions.
Various substances have been used to soak the packing:
oNormal saline
oEstrogen cream (Premarin)
oPetroleum jelly
oAcroflavin
oBupivacaine
oNot soaked at all
There is no documented standard in the literature.

Study Objectives:

Determine if there is any difference in outcomes between  estrogen, bupivacaine and saline-soaked vaginal packing, in patients following pelvic floor reconstructive surgery. 

●The primary outcome is post-operative pain, as rated by patients using a visual analog scale (VAS) at 2 and 6 hours post-surgery and on the morning of POD#1. ●Secondary outcomes include: intra-operative estimated blood loss (EBL), change in hemoglobin, urinary retention (as measured by trial of void), and length of stay (LOS) in hospital.

Rationale:

If saline-soaked vaginal packing is shown to be non-inferior in post-operative outcomes, it may become the least expensive choice for patients undergoing vaginal surgery.

Methods:

Patients scheduled for pelvic floor reconstructive surgery (vaginal or vaginal + laparoscopic surgery) at Sunnybrook Health Sciences Centre were recruited to participate in this prospective cohort study
At the end of surgery, depending on the physician’s standard of practice, patients received vaginal packing soaked with estrogen cream (Premarin), 0.25% bupivacaine + epinephrine, or normal saline. 
Patients were then asked at 2 hours and 6 hours post-surgery and the morning of POD#1 to rate their pain with a standardized validated VAS pain score. 
Secondary outcomes were also recorded: EBL, change in post-operative hemoglobin (compared to pre-operative hemoglobin), urinary retention (as measured by trial of void) and LOS in hospital.
Statistical analysis between the 3 treatment groups were conducted to evaluate significant difference in pain scores between the groups (estrogen vs. bupivacaine vs. saline).
Appropriate tests were also conducted to look at secondary outcomes.

Results:

Figure 1. a)There were no significant differences in EBL between subjects in the different treatment groups (p=0.89). EBL was recorded as 0-9, corresponding to volume of blood lost (cc) indicated in the table above. b)There were no significant differences in change in hemoglobin between subjects in the different groups (p=0.68). c)Trial of void was recorded as 1 for yes and 0 for no. There were no significant differences between treatment groups (p=0.45). d)There were no significant differences in length of hospital stay between subjects in different treatment groups (p=0.97). Data is displayed as mean ± SD.

Figure 2.There were no significant differences between any of the three treatment methods onVAS scores at 2 hours, 6 hours, and 1 day post-surgery. Data is displayed as mean ± SD.

Conclusions:

This study did not find a difference between the use of estrogen cream, bupivacaine, and saline with vaginal packing after pelvic floor reconstructive surgery on post-operative VAS pain scores, EBL, change in hemoglobin, urinary retention, or LOS. Saline soaked packing is an equivalent, but less expensive, alternative to estrogen or bupivacaine vaginal packing.

Enter Poster ID (e.gGoNextPreviousCurrent