Giugale LE, Baranski LA, Meyn LA, et al. - Researchers here examined postoperative pain after vaginal native tissue prolapse repairs in correlation with administering preoperative pelvic floor muscle injections and pudendal nerve blocks with bupivacaine and dexamethasone vs saline and bupivacaine. In this three-arm, double-blind, randomized trial, bilateral transobturator levator ani muscle injections and transvaginal pudendal nerve blocks were administered before vaginal reconstructive and obliterative prolapse procedures (uterosacral ligament suspension, sacrospinous ligament fixation, levator myorrhaphy, or colpocleisis). On screening 281 women, they randomized 75 (26.7%) women with no differences in baseline demographics to one of three study medication groups: 0.9% saline, 0.25% bupivacaine, or combination 0.25% bupivacaine with 4 mg dexamethasone. Outcomes revealed that preoperative pelvic floor muscle injections and pudendal nerve blocks with bupivacaine and dexamethasone does not correlate with improved postoperative pain after vaginal native tissue prolapse procedures.