2234 Comparing Pain Levels and Blood Loss Following Pelvic Floor Reconstructive Surgery Between Vaginal Packing Soaked with Either Estrogen, Bupivacaine or Saline

Study Objective To determine if there is any difference in outcomes between estrogen, bupivacaine and saline-soaked vaginal packing, in patients following pelvic floor reconstructive surgery (PFRS). The primary outcome is post-operative pain, as rated by patients using a visual analog scale (VAS) 2 and 6 hours post-surgery and on the morning of post-operative day1 (POD#1). Secondary outcomes include: intra-operative estimated blood loss (EBL), change in hemoglobin, pain medication use, urinary retention, and length of stay (LOS) in hospital. Design Prospective cohort study. Setting Tertiary academic care center. Patients or Participants Patients undergoing PFRS for pelvic organ prolapse and/or stress urinary incontinence by four trained urogynecologists at an academic center. 142 patients have been enrolled. Interventions Women undergoing vaginal surgery received vaginal packing that was soaked with saline, 0.25% Bupivacaine or conjugated estrogen vaginal cream, according to physician preference. Measurements and Main Results The study population included 142 patients (saline: n=40; bupivacaine: n=47; estrogen: n=55). Results of ANOVA showed no significant differences between the three treatment methods for post-operative pain scores (at 2 hours and 6 hours post-surgery as well as morning of POD#1). The average VAS (2hours) was 2.24, 2.30 and 2.66 and among patients receiving saline, Bupivacaine and estrogen respectively (p=0.4656). There were no significant differences between any of the three treatment methods in VAS pain scores at 6 hours (p=0.2181), and POD#1 (p=0.2832). No significant difference was found with EBL between the three groups (p=0.8914). Conclusion This study did not find a difference between the use of saline, bupivacaine and estrogen cream with vaginal packing after pelvic floor reconstructive surgery on post-operative VAS pain scores, EBL, LOS or urinary retention. Saline soaked packing is an equivalent, but less expensive, alternative to estrogen or bupivacaine vaginal packing – and could replace estrogen-soaked packing in those who have contraindications to estrogen use.