Effect of Local Anesthesia on Postoperative Pain Following Sacrospinous Ligament Fixation

During surgery for pelvic organ prolapse, it is common for the surgeon to inject fluid into the vaginal tissues to help with tissue dissection. It is common that anesthetic medication is mixed into this fluid to help with pain control after surgery. Usually the pain medication injected is short-acting. In this study the investigators plan to compare the usual short-acting injected pain medication with a long-acting injected pain medication to evaluate whether this improves pain control after surgery. One type surgical procedure for prolapse will be evaluated. The procedure is sacrospinous ligament fixation. This is suspension of the vagina to treat pelvic organ prolapse. Study participants will be randomized to one of two study groups: Lidocaine group (short-acting medication). Liposomal bupivacaine group (long-acting medication) Information will be collected on study participants, including: demographics, procedure data, and post-operative information. The primary outcome of this study is determine if use of long-acting injected local anesthesia at the time of sacrospinous ligament fixation leads to less post-operative pain compared to short-acting local anesthesia. Secondary outcomes include: post-operative opioid medication use return to baseline pain status post-operative time to first bowel movement post-operative antiemetic use (nausea medication) results of voiding trial after surgery patient satisfaction with pain control

0.5% lidocaine mixed with 1:200,000 epinephrine 70 milliliters (mL) will be used for local injection at the sacrospinous ligament and for anterior / posterior colporrhaphy

1.3% bupivacaine liposomal (20 mL) injected at the sacrospinous ligament 0.5% lidocaine mixed with 1:200,000 epinephrine 50mL for the anterior / posterior colporrhaphy

Inclusion Criteria: Female gender Age ≥ 18 years, ≤95 years Planned vaginal sacrospinous ligament fixation with anterior and/or posterior colporrhaphy (SSLF APC) to treat pelvic organ prolapse with or without retropubic mid urethral sling Able to give informed consent to participate Exclusion Criteria: Male Age <18 years, > 95 years Unable or unwilling to give informed consent to participate Pregnancy History of chronic pelvic pain, narcotic abuse, or daily narcotic usage in the last six months Known allergy / intolerance to either lidocaine, bupivacaine liposomal, ketorolac, motrin, or acetaminophen Known renal or hepatic insufficiency Planned hysterectomy at the time of prolapse repair Planned transobturator mid urethral sling at the time of prolapse repair