Patient Satisfaction and Pain Control Following Reconstructive Vaginal Surgery

• Patient Satisfaction with Pain Control [ Time Frame: post operative day 1 ] [ Designated as safety issue: No ]
  Patient's satisfaction with pain control on a VAS on all postoperative day one.
• patient perceived pain at 2 weeks [ Time Frame: 2 weeks post op ] [ Designated as safety issue: No ]
  VAS for pain will be filled out at the patient's two week post op office visit.
• patient dissatisfaction with pain control at 2 weeks [ Time Frame: 2 weeks post op ] [ Designated as safety issue: No ]
  patient will fill out a VAS for satisfaction with pain control at their two week post operative visit.

The investigators hypothesize that patient controlled analgesia (PCA) provides superior pain relief and patient satisfaction when compared to scheduled intravenous analgesia following vaginal reconstructive surgery.

The investigators hypothesize that patient controlled analgesia (PCA) provides superior pain relief and patient satisfaction when compared to scheduled intravenous analgesia following vaginal reconstructive surgery.

In order to determine if there is a significant correlation, secondary outcomes will include the daily and total narcotic volume used, common side effects from the opioid including nausea, vomiting, or pruritis, length of hospital stay, timing of flatus and first bowel movement, all complications, and procedure performed.

• Drug: Dilaudid PCA
  PCA setting of 0.3mg demand dose, 8 minute lock out interval, and 5mg 4-hour limit.
  Other Name: hydromorphone
• Drug: Dilaudid IV Scheduled
  Nurse administered IV Dilaudid 0.5mg every 2 hours.
  Other Name: hydromorphone

• Experimental: Scheduled IV post op
  Patient's will receive scheduled nurse administered IV pain medications post operatively.
  Intervention: Drug: Dilaudid IV Scheduled
• Experimental: PCA post op
  Patients will receive PCA for pain control post operatively.
  Intervention: Drug: Dilaudid PCA

Inclusion Criteria:

• The patients will be limited to those from the Division of Urogynecology to ensure similar surgical techniques. They will be between the ages of 18 and 70 and undergoing major vaginal reconstruction.
• All patients must undergo vaginal reconstructive surgery including: anterior repair, posterior repair, and intraperitoneal vaginal vault suspension. The addition of vaginal hysterectomy, enterocele repair, or suburethral sling is not cause for exclusion.

Exclusion Criteria:

• Any patient who has an allergy to hydromorphone/Dilaudid.
• Any patient already taking chronic opioids, defined as daily use.
• All patients with renal insufficiency or failure.
• All patients with liver failure.
• Any patient who is not having general anesthesia.
• Any patient undergoing abdominal or laparoscopic procedures: sacral colpopexy, laparoscopic hysterectomy or oophorectomy, Burch procedure, or any procedure that enters the abdominal fascia.