Fertility and Sterility
Volume 94, Issue 2 , Pages 436-443, July 2010

A prospective, randomized, double-blind, placebo-controlled trial of multimodal intraoperative analgesia for laparoscopic excision of endometriosis

The findings of this study were presented at the Australian Gynaecological Endoscopy Society (AGES) XVII Annual Scientific Meeting, Sydney, Australia on May 18, 2007, and the Fertility Society of Australia (FSA) Annual Conference, Hobart, Australia on September 11, 2007.

  • Michael F. Costello, F.R.A.N.Z.C.O.G., CREI.

      Affiliations

    • 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
    • Department of Reproductive Medicine and IVF Australia, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia
    • Corresponding Author InformationCorresponding author: Dr Michael Costello, School of Women's and Children's Health, Division of Obstetrics and Gynaecology, Level 1 Women's Health Institute, Royal Hospital for Women, Locked Bag 2000, Randwick, Sydney, New South Wales, Australia, 2031 (FAX: 61-2-9382 6444).
    • ,
  • Jason Abbott, F.R.A.N.Z.C.O.G., Ph.D.

      Affiliations

    • 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
    • Department of Endogynaecology, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia
    • ,
  • Steven Katz, F.A.N.Z.C.A.

      Affiliations

    • Department of Anaesthesia, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia
    • ,
  • Thierry Vancaillie, F.R.A.N.Z.C.O.G.

      Affiliations

    • 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
    • Department of Endogynaecology, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia
    • ,
  • Sally Wilson, R.N.

      Affiliations

    • Department of Anaesthesia, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia

Received 13 November 2008; received in revised form 19 February 2009; accepted 9 March 2009. published online 27 April 2009.

Objective

To assess the efficacy of multimodal intraoperative analgesia in reducing postoperative pain and/or opioid requirements in women undergoing laparoscopic excision of endometriosis.

Design

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

Setting

Endogynecologic department of a university teaching hospital.

Patient(s)

Women booked for laparoscopic excision of endometriosis.

Intervention(s)

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.

Main Outcome Measure(s)

Postoperative total hospital opioid analgesic requirements and postoperative pain intensity.

Result(s)

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.

Conclusion(s)

The use of multimodal intraoperative analgesia at laparoscopic excision of endometriosis reduces postoperative opioid requirements.

Key Words: Analgesia, endometriosis, laparoscopy

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 M.F.C. has nothing to disclose. J.A. has nothing to disclose. S.K. has nothing to disclose. T.V. has nothing to disclose. S.W. has nothing to disclose.

 Supported by Australian Gynaecological Endoscopy Society (AGES) Grant 2003-2004 and Royal Hospital for Women Foundation Grant 2003.

 Reprints will not be available.

PII: S0015-0282(09)00586-X

doi:10.1016/j.fertnstert.2009.03.025

Fertility and Sterility
Volume 94, Issue 2 , Pages 436-443, July 2010

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