Pain level and analgesic requirements in patients who underwent vaginal pelvic floor surgery following general or spinal anesthesia

Objective: This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent GA or SA during vaginal pelvic floor surgeries. Design: A retrospective cohort study. Participants/Materials, Setting, Methods: Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery. Results: During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, P=0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p=0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient’s age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR= 0.33, p=0.008) and mid-urethral sling placement (aOR= 0.37, p=0.004). Limitaions: This is a rerospective study, thus the choice of anesthesia may be biased. Conclusion: SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries. Keywords: GENERAL ANESTHESIA; SPINAL ANESTHESIA, ANALGESIA, PELVIC FLOOR SURGERY, PELVIC ORGAN PROLAPSE, STRESS URINARY INCONTINENCE, ERAS. Synopsis: Vaginal pelvic floor surgeries under spinal anesthesia is associated with less postoperative pain and intravenous analgesia requirement