OBJECTIVE: The role of preemptive analgesia in relieving pain following transvaginal pelvic reconstructive surgery has not yet been investigated. We aimed to assess the effect of preemptive pudendal nerve blockade on pain and consumption of narcotic analgesia following transvaginal pelvic reconstructive surgery. METHODS: This was a prospective, randomized, double blind, placebo-controlled trial. Patients undergoing transvaginal pelvic reconstructive surgery under general anesthesia were randomized to receive pudendal block with either bupivacaine 0.25% or placebo (normal saline 0.9%) immediately before surgery. All surgeries were performed transvaginally, under general anesthesia induced by intravenous fentanyl 2μg/kg and propofol 2mg/kg. All patients received postoperative intravenous hydromorphone patient controlled analgesia. Patients were asked to report on their pain intensity 1, 3, 5, 7, 18 and 24 hours postoperatively, using a validated visual analogue pain scale from 0–10. Analgesic requirements were consistently recorded at 3, 7, 18 and 24 hours after surgery. Main outcome measures included postoperative pain severity, and hydromorphone consumption. RESULTS: One hundred and ten patients enrolled in the study, of which 106 were randomized, and 102 received preemptive pudendal block analgesia, 51 with bupivacaine 0.25% and 51 with normal saline. The 2 patient groups did not differ in baseline demographic and clinical characteristics, surgical procedures, anesthetic dose, total blood loss, operative time, surgical and medical complications. There were no significant differences between the 2 groups in mean postoperative pain scores (1 hour: 4.63 vs. 4.80; 3 hours: 3.71 vs. 3.87; 5 hours: 2.89 vs. 3.10; 7 hours: 2.85 vs. 3.12; 18 hours: 3.22 vs. 3.47; 24 hours: 3.23 vs. 3.12), and consumption of intravenous hydromorphone (0–3 hours: 1.84 vs. 1.77 mg; 4–7 hours: 1.19 vs. 1.20 mg; 8–18 hours: 2.89 vs. 2.35 mg). Additional boluses of hydromorphone (18% vs. 18%) and ketoralac (12% vs. 8%), as well as mean oral hydrocodone (10.6 vs. 12.7mg) and ibuprofen (630 vs. 762 mg) consumption in the first 24 hours after surgery were not significantly different between the two groups. There were no significant differences in mean total hospital stay between the 2 patient groups (39.6 vs. 37.3 hours). There were no complications directly related to the pudendal nerve blockade in any of the study patients. CONCLUSIONS: Preemptive pudendal nerve blockade does not affect postoperative pain intensity or the consumption of narcotic analgesia following pelvic reconstructive surgery.