REDUCTION OF PAIN AFTER LAPAROSCOPIC STERILIZATION WITH LOCAL BUPIVACAINE - A RANDOMIZED, PARALLEL, DOUBLE-BLIND TRIAL

Objective To investigate the efficacy of applying 20 ml bupivacaine 0.5% versus normal saline to the fallopian tubes under direct vision during day case laparoscopic sterilisation under general anaesthesia. Design Randomised, parallel, double-blind controlled trial. Setting Day Surgery Unit. Subjects Sixty women presenting for day case laparoscopic sterilisation. Main outcome measures Time to first post-operative analgesia, and pain levels at 1 h, at discharge, and at time of first analgesia. Results In the group receiving bupivacaine, time to first analgesia was significantly longer (P = 0.03) and significantly fewer patients requested escape analgesia before the 1 h assessment (P = 0.01). This group also had significantly less pain on visual analogue scale (P = 0.04) and significantly lower categorical verbal pain scores (P = 0.01) at the 1 h assessment. By the time of discharge, there were no significant differences between the groups. Eight women in the saline group and 15 in the bupivacaine group required no escape analgesia. This difference was not significant. One woman who received saline required to be admitted overnight for severe pain. Conclusion Topical application of bupivacaine to the fallopian tubes during laparoscopic sterilisation is an easy and effective contribution to the management of pain in the immediate post-operative period after day case laparoscopic sterilisation under general anaesthesia.