POSTOPERATIVE PAIN RELIEF FOLLOWING LAPAROSCOPIC TUBAL-STERILIZATION WITH SILASTIC BANDS

Objective: To evaluate postoperative pain relief of intramuscular keto rolac, topical bupivacaine, and placebo in patients undergoing laparos copic tubal sterilization with silastic bands. Methods: One hundred fi ve women undergoing laparoscopic tubal sterilization with silastic ban ds were randomized to one of three groups: one received intramuscular ketorolac and topical placebo applied to the fallopian tubes, the seco nd received intramuscular placebo and topical bupivacaine, and the thi rd received intramuscular placebo and topical placebo. Surgical proced ures, anesthesia, and recovery were conducted with standardized protoc ols. Postoperative pain perception was graded using the modified McGil l pain intensity scale at 30 minutes postoperatively, at discharge fro m the recovery room, and the next morning by telephone interview. Othe r measured variables included postoperative vomiting, additional analg esia requirement, and length of time spent in the recovery room. Resul ts: Only topical bupivacaine was found to decrease postoperative pain scores significantly over those with placebo, at 30 minutes postoperat ively (median score 2 compared with 4, P = .002) and at discharge from the recovery room (median score 2 compared with 3, P = .03). There wa s no significant decrease in pain scores with intramuscular ketorolac compared with placebo. No differences in pain scores were found betwee n the three groups at the next morning phone call. There were no signi ficant differences between the three groups with respect to requiremen ts for supplemental pain medications in the recovery room, incidence o f postoperative vomiting, or length of time spent in the recovery room . Conclusion: Topical bupivacaine decreases postoperative pain scores significantly compared with placebo in women undergoing laparoscopic t ubal sterilization with silastic bands. (C) 1997 by The American Colle ge of Obstetricians and Gynecologists.