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  • Title: Reduction of pain after laparoscopic sterilisation with local bupivacaine: a randomised, parallel, double-blind trial.
    Author: Wheatley SA, Millar JM, Jadad AR.
    Journal: Br J Obstet Gynaecol; 1994 May; 101(5):443-6. PubMed ID: 8018619.
    Abstract:
    OBJECTIVE: To investigate the efficacy of applying 10 ml bupivacaine 0.5% versus normal saline to the fallopian tubes under direct vision during day case laparoscopic sterilisation under general anaesthesia. DESIGN: Randomised, parallel, double-blind controlled trial. SETTING: Day Surgery Unit. SUBJECTS: Sixty women presenting for day case laparoscopic sterilisation. MAIN OUTCOME MEASURES: Time to first post-operative analgesia, and pain levels at 1 h, at discharge, and at time of first analgesia. RESULTS: In the group receiving bupivacaine, time to first analgesia was significantly longer (P = 0.03) and significantly fewer patients requested escape analgesia before the 1 h assessment (P = 0.01). This group also had significantly less pain on visual analogue scale (P = 0.04) and significantly lower categorical verbal pain scores (P = 0.01) at the 1 h assessment. By the time of discharge, there were no significant differences between the groups. Eight women in the saline group and 15 in the bupivacaine group required no escape analgesia. This difference was not significant. One woman who received saline required to be admitted overnight for severe pain. CONCLUSION: Topical application of bupivacaine to the fallopian tubes during laparoscopic sterilisation is an easy and effective contribution to the management of pain in the immediate post-operative period after day case laparoscopic sterilisation under general anaesthesia. Laparoscopic sterilization is a common day case procedure. It is, however, known to be associated with more post-operative pain than diagnostic laparoscopy most likely due to the effects of clips or rings applied during the procedure to the fallopian tubes. This pain can delay or prevent discharge from the medical facility, as can nausea associated either with the pain or narcotic analgesics given for it. There are conflicting reports on the effectiveness of local anesthetic applied to the tubes in reducing pain. A randomized, parallel, double-blind controlled trial using sixty women presenting for day case laparoscopic sterilization was therefore conducted in the day surgery unit to investigate the efficacy of applying 10 ml of bupivacaine 0.5% versus normal saline to the fallopian tubes under direct vision during day case laparoscopic sterilization under general anesthesia. In the group receiving bupivacaine, time to first analgesia was significantly longer and significantly fewer patients requested escape analgesia before the one hour assessment; the group also had significantly less pain on visual analog scale and significantly lower categorical verbal pain scores at the one hour assessment. By the time of discharge, there were no significant differences between the groups. Eight women in the saline group and fifteen in the bupivacaine group required no escape analgesia, but this difference was not significant. One woman who received saline, however, required to be admitted overnight for severe pain. The topical application of bupivacaine to the fallopian tubes during laparoscopic sterilization was therefore found to be an easy and effective contribution to the management of pain in the immediate post-operative period after day case laparoscopic sterilization under general anesthesia.
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