Use of Cyclobenzaprine After Vaginal Surgery

The management of post-operative pain in patients after vaginal surgery provides many
unforeseen challenges. Although vaginal surgery is considered a minimally invasive approach
for the repair of pelvic floor prolapse and urinary incontinence, patients may still
experience varying degrees of discomfort and post-operative pain. Narcotics, however, can
introduce a host of problems in addition to the potential addictive properties of the
medication. A vicious cycle ensues as patients seek better pain control at the expense of
worsening constipation, but without adequate control of pain after surgery, voiding
dysfunctions are often exaggerated.

Cyclobenzaprine (Flexeril®) in conjunction with NSAIDs has long been the basis for
management of acute musculoskeletal injuries, but the practice of prescribing this centrally
acting muscle relaxant for post-operative patients has also been successful in the
management of pain.

An online search of medical databases revealed that there are currently no published
retrospective or prospective studies determining the efficacy of cyclobenzaprine in post
surgical patients in conjunction with traditional pain management. The investigators
hypothesize among healthy patients undergoing elective vaginal surgery for pelvic organ
prolapse, the short-term use of a muscle relaxant could reduce the spasticity of the pelvic
floor muscle attributable to surgery and thereby reduce the use of narcotics. Consequently,
the reduction of narcotics and the control of post-surgical pain may also hasten the return
of normal urinary and defecatory function.