Postoperative pain relief following laparoscopic tubal sterilization with silastic bands.
OBJECTIVE
To evaluate postoperative pain relief of intramuscular ketorolac, topical bupivacaine, and placebo in patients undergoing laparoscopic tubal sterilization with silastic bands.


METHODS
One hundred five women undergoing laparoscopic tubal sterilization with silastic bands were randomized to one of three groups: one received intramuscular ketorolac and topical placebo applied to the fallopian tubes, the second received intramuscular placebo and topical bupivacaine, and the third received intramuscular placebo and topical placebo. Surgical procedures, anesthesia, and recovery were conducted with standardized protocols. Postoperative pain perception was graded using the modified McGill pain intensity scale at 30 minutes postoperatively, at discharge from the recovery room, and the next morning by telephone interview. Other measured variables included postoperative vomiting, additional analgesia requirement, and length of time spent in the recovery room.


RESULTS
Only topical bupivacaine was found to decrease postoperative pain scores significantly over those with placebo, at 30 minutes postoperatively (median score 2 compared with 4, P = .002) and at discharge from the recovery room (median score 2 compared with 3, P = .03). There was no significant decrease in pain scores with intramuscular ketorolac compared with placebo. No differences in pain scores were found between the three groups at the next morning phone call. There were no significant differences between the three groups with respect to requirements for supplemental pain medications in the recovery room, incidence of postoperative vomiting, or length of time spent in the recovery room.


CONCLUSIONS
Topical bupivacaine decreases postoperative pain scores significantly compared with placebo in women undergoing laparoscopic tubal sterilization with silastic bands.
Tool
A L
AL
Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, USA.
Kammerer-Doak
D N
DN
Nguyen
C M
CM
Cousin
M O
MO
Charsley
M
M
D000328:Adult; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002045:Bupivacaine; D005260:Female; D006801:Humans; D007476:Ionophores; D020910:Ketorolac; D010535:Laparoscopy / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012826:Silicone Elastomers; D013246:Sterilization, Tubal / Q000379:methods*; D013997:Time Factors; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives*
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007476:Ionophores; D012826:Silicone Elastomers; D014046:Tolmetin; D002045:Bupivacaine; D020910:Ketorolac