The effect of vaginal closure technique on early post-operative pain following vaginal prolapse surgery: a feasibility pilot study and qualitative assessment

Abstract

BackgroundSurgery for pelvic organ prolapse is a common surgical procedure. There is little research studying post-operative pain, contrasting with extensive literature on pain after childbirth trauma which shows that suture method has a significant effect on pain. We designed a protocol for a trial comparing suture techniques and post-operative pain, and conducted a pre-protocol pilot to inform our trial design.MethodsRoutine surgical data, post-operative pain scores (from 10 cm Visual Analogue Scales, VAS) and analgesic requirements were obtained from the notes of a cohort of women undergoing vaginal prolapse surgery. Median VAS scores at 4, 12 and 24 hours were compared by suture material used and method of closure (single continuous suture or interrupted sutures). The women whose data were obtained were invited to attend focus groups of up to six people in the twelve weeks following surgery. A semi structured question guide was used, and interviews were recorded, transcribed anonymously and analysed using the constant comparative method of grounded theory. Ethical approval was not sought because formal pre-protocol work is exempt for UK ethical requirements, but formal written consent on standard forms was obtained for publishing outcomes and anonymised comments from participants.ResultsComplete VAS data and operative details were available from 41 women. Surgery was completed using absorbable polyglactin sutures with continuous suturing (17 women) or interrupted sutures (24 women). Pain scores at 4 and 12 hours were similar; pain at 24 hours was greater in the women with interrupted sutures (median VAS 3 (range 0–8) versus 1.5 (0–8) (p = 0.0513). Analgesic needs were similar.Two focus groups (nine participants) revealed that women regarded post-operative pain as insignificant and not a topic worthy of formal research. It was apparent that the use, and especially removal of, vaginal packs was a practice associated with pain which women remembered as a significant part of their post-operative experience.ConclusionsFormal pre-protocol work is informative; we found a moderate difference in our proposed outcomes, suggesting a trial was feasible but women themselves were unconvinced of the need for formal research into pain following vaginal surgery.

Evolution of the Araliaceae family inferred from complete chloroplast genomes and 45S nrDNAs of 10 Panax-related species

“…Most genetic diversity studies in plants have focused on ITS1 and ITS2 regions 34–38 . However, our study demonstrates that there is sufficient genetic diversity in the ribosomal gene regions for evolutionary analysis (Fig.…”

Levels of DNA methylation and transcript accumulation in leaves of transgenic maize varieties

“…Koul et al [72] showed a correlation between transcript accumulation and Bt protein in different transgenic tomato lines expressing the cry1Ab transgene. Olsen et al [73] found that the developmental decline in bioefficacy (against Helicoverpa armigera ) in field-grown plants was associated with reduced cry1Ac transcript levels and Bt toxin levels in postsquaring cotton.…”

Effect of lipid peroxidation on membrane permeability of cancer and normal cells subjected to oxidative stress

“…Moreover, besides in vitro studies, several interesting in vivo studies have been presented. 16,17 It is stated that plasma can selectively treat cancer cells, while leaving the healthy cells undamaged, 2,3,18,19,23–25 and up to now, cancer cells have not yet developed resistance against plasma treatment. 2,3 Furthermore, there is a synergistic effect of plasma treatment and traditional therapies.…”