title: Ketorolac-mepivacaine lower uterine block for in-office endometrial ablation: a randomized, controlled trial.
abstract: OBJECTIVE
  To investigate the effectiveness of a nonsteroidal antiinflammatory drug (NSAID) administered in combination with a local anesthetic as a deep paracervical block for in-office endometrial ablations.
  
  
  METHODS
  Double-blind, placebo-controlled, randomized trial. Patients received either sublingual ketorolac (30 mg/1 mL) or a mepivacaine-only paracervical injection (standard group) or received sublingual saline (1 mL) and a ketorolac (30 mg/1 mL)-mepivacaine paracervical block (NSAID group)for Gynecare Thermachoice III ablation (Ethicon, Inc., Somerville, New Jersey). All received sublingual ketorolac/placebo and 1 mg alprazolam sublingually 20 minutes preprocedure. Primary outcome was intraoperative pain control measured by 100 mm visual analogue scale. Secondary outcomes were postablation pain control (visual analogue scale [VAS]), postoperative use of narcotic analgesics and patient satisfaction in the first 24 hours (not satisfied, satisfied or very satisfied).
  
  
  RESULTS
  Twenty patients were randomized into each group. No statistically significant difference was noted in overall intraoperative VAS score (p = 0.81), but there was a significant reduction in postoperative VAS (p = 0.01). There was less need for postoperative analgesic use in the first 24 hours (p = 0.02) in the NSAID group. More patients were "very satisfied" in the NSAID group.
  
  
  CONCLUSIONS
  Injectable ketorolac-mepivacaine anesthetic solution functions well as a deep paracervical block for in-office gynecologic procedures, with better postoperative pain control than mepivacaine-alone protocols.
authors.affiliation: Women's Specialty Center, Dallas, Texas, USA. chapamd@aol.com
authors.forename: Hector O
authors.initials: HO
authors.lastname: Chapa
authors.forename: Alfred G
authors.initials: AG
authors.lastname: Antonetti
authors.forename: Ken
authors.initials: K
authors.lastname: Bakker
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D015331:Cohort Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D055356:Endometrial Ablation Techniques / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage*; D008619:Mepivacaine / Q000008:administration & dosage*; D009294:Narcotics / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D008619:Mepivacaine; D020910:Ketorolac