A prospective, randomized, double-blind, placebo-controlled trial of multimodal intraoperative analgesia for laparoscopic excision of endometriosis.
OBJECTIVE
To assess the efficacy of multimodal intraoperative analgesia in reducing postoperative pain and/or opioid requirements in women undergoing laparoscopic excision of endometriosis.


METHODS
Prospective, randomized, double-blind, placebo-controlled trial.


METHODS
Endogynecologic department of a university teaching hospital.


METHODS
Women booked for laparoscopic excision of endometriosis.


METHODS
Intraoperative multimodal analgesia versus placebo. Analgesia consisted of Diclofenac sodium 100 mg suppository per rectum and 0.75% Ropivacaine to portal sites, subperitoneally under excision sites and topically to each subdiaphragmatic area.


METHODS
Postoperative total hospital opioid analgesic requirements and postoperative pain intensity.


RESULTS
The study was terminated prematurely, after a planned interim analysis (which included 66 randomized patients or 43% of the planned number of patients) found significantly less total hospital opioid requirements in the analgesic group compared with the placebo group (19.0 mg vs. 34.5 mg; difference -14.0 mg [95% confidence interval -26.0 to -2.0 mg]). There was no difference in postoperative pain intensity between the two groups.


CONCLUSIONS
The use of multimodal intraoperative analgesia at laparoscopic excision of endometriosis reduces postoperative opioid requirements.
Costello
Michael F
MF
School of Women's and Children's Health, Division of Obstetrics and Gynaecology, University of New South Wales, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia. mfcostello@unsw.edu.au
Abbott
Jason
J
Katz
Steven
S
Vancaillie
Thierry
T
Wilson
Sally
S
D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000698:Analgesia / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D004008:Diclofenac / Q000008:administration & dosage*; D004311:Double-Blind Method; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control; D010919:Placebos; D011446:Prospective Studies; D000077212:Ropivacaine; D055815:Young Adult
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010919:Placebos; D004008:Diclofenac; D009020:Morphine; D000077212:Ropivacaine