EFFECTS OF KETOPROFEN AND MESOSALPINX INFILTRATION ON POSTOPERATIVE PAIN AFTER LAPAROSCOPIC STERILIZATION

Objective: To determine whether preoperative ketoprofen and mesosalpin x infiltration, either alone or in combination favorably influence pos toperative recovery after outpatient laparoscopic sterilization. Metho ds: in a double-blind, randomized, placebo-controlled study, 20 women received 200 mg of oral ketoprofen preoperatively, and each mesosalpin x was infiltrated with 5 mL of saline plus epinephrine 1:200,000; 20 w omen were given oral ketoprofen, and each mesosalpinx was infiltrated with 5 mL of bupivacaine 0.5% with epinephrine 1:200,000; and 20 women received a placebo capsule with mesosalpinx infiltration, Pain was as sessed by a visual analogue scale and a self-assessment 11-point scale ; outcome was assessed by discharge time, consumption of analgesics, i ncidence of nausea and vomiting, and the number of postoperative days to full recovery. Results: Pain ratings in the ketoprofen-only group w ere significantly higher than in the two other groups (P < .001). Preo perative ketoprofen alone provided insufficient postoperative pain rel ief, necessitating the use of opiates and peripheral analgesics. Nause a and vomiting were highest in these subjects, as was intake of periph eral analgesics at home. Times to discharge were also the longest in t his group (median 385 minutes, range 260-510) and differed significant ly from both other groups (P < .001). It took 4-13 days to recover. In contrast, women with only a mesosalpinx block ambulated and recovered sooner, but times to discharge were still prolonged (median 240 minut es, range 105-375). Recovery usually occurred by the fourth postoperat ive day. The combination of preoperative ketoprofen and mesosalpinx bl ock resulted in the shortest times to discharge (median 190 minutes, r ange 80-330), the least consumption of peripheral analgesics, and the lowest incidence of nausea and vomiting. Recovery occurred by the four th postoperative day. Conclusion: Mesosalpinx infiltration has a favor able effect on postoperative recovery after day-surgery laparoscopic s terilization. Still better results can be obtained with a multimodal a nalgesic approach, combining mesosalpinx infiltration with preoperativ e ketoprofen.