Randomized controlled trial investigating the effect of transcervical papaverine and bupivacaine on postoperative analgesia following laparoscopic sterilization.
OBJECTIVE
A critical factor that delays patient discharge following day-surgery is severe postoperative pain and the requirement for strong analgesics. Laparoscopic sterilization is a day case procedure and is associated with additional postoperative pain compared with diagnostic laparoscopy. This pain, associated with application of Filshie clips, may be ischaemic or spasmodic in aetiology. Papaverine relaxes smooth muscle, and the aim of the study was to investigate if papaverine would be effective in improving postoperative pain if administered directly to the Fallopian tubes. Bupivacaine is used commonly in day-surgery and so we compared the effect of this local anaesthetic with saline placebo.


METHODS
Sixty-six ASA I-II females undergoing laparoscopic sterilization were entered into the prospective, randomized, double-blind, placebo-controlled clinical trial. They received intrauterine papaverine (30 mg) or bupivacaine (0.375% 30 mL) or normal saline (30 mL) via the transcervical route before application of Filshie clips.


RESULTS
There were no significant differences in the postoperative period between the three groups in the number of patients needing analgesia in the first 60 min postoperatively, the time to first analgesia, the rescue analgesic or antiemetic consumption, the incidence of postoperative nausea and vomiting, and the sedation and visual analogue pain scores.


CONCLUSIONS
From the data presented, we would not recommend routine transcervical administration of papaverine or bupivacaine for pain following laparoscopic sterilization.
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Leicester Royal Infirmary, University Department of Anaesthesia, Critical Care & Pain Management, UK. anae@le.ac.uk
Habib
A
A
Swami
A
A
Smith
G
G
Nunns
D
D
Davidson
A C
AC
D000287:Administration, Topical; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D010535:Laparoscopy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D010208:Papaverine / Q000008:administration & dosage*; D010276:Parasympatholytics / Q000008:administration & dosage; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D013246:Sterilization, Tubal; D014599:Uterus
D000700:Analgesics; D000779:Anesthetics, Local; D010276:Parasympatholytics; D010726:Phosphodiesterase Inhibitors; D010208:Papaverine; D002045:Bupivacaine