EFFECTIVE ANALGESIA AFTER BILATERAL TUBAL-LIGATION

Postpartum bilateral tubal ligation is a brief surgical procedure with minimal tissue injury, yet postoperative recovery times and analgesia requirements are often disproportionately large. To evaluate the anal gesic efficacy of local anesthetic infiltration, 20 parturients schedu led for elective minilaparotomy and bilateral tubal ligation with eith er spinal or epidural anesthesia participated in this prospective, ran domized, controlled, double-blind trial. All patients received IV meto clopramide 10 mg and ketorolac 60 mg intraoperatively, as well as prei ncisional infiltration of the infraumbilical skin incision with 0.5% b upivacaine. Infiltration of bilateral uterine tubes and mesosalpinx wa s performed with either 0.5% bupivacaine (n = 10) or isotonic sodium c hloride solution (saline) (n = 20). TV meperidine (25 mg every 3 min a s needed) was given to treat pain in the postanesthesia care unit (PAC U). The total amount of meperidine administered in the PACU was signif icantly larger in the saline group than in the bupivacaine group. Pain scores at 30, 45, 60, 75, and 90 min postoperatively and on the seven th postoperative day were significantly lower in the bupivacaine group than in the saline group. During tubal ligation, infiltration of uter ine tubes and mesosalpinx with 0.5% bupivacaine significantly enhanced analgesia both in the immediate postoperative setting and on the seve nth postoperative day compared with infiltration with sodium chloride. Implications: During bilateral tubal Ligation with either spinal or e pidural anesthesia, preemptive analgesia using IV ketorolac, IV metocl opramide, and infiltration of the incised skin and uterine tubes with 0.5% bupivacaine allowed 9 of 10 patients to recover with no pain, nau sea, vomiting, or cramping and to maintain good analgesia for 7 days p ostoperatively.