A prospective, randomized, double-blind, placebo-controlled trial of multimodal intraoperative analgesia for laparoscopic excision of endometriosis
Michael F Costello1, Jason Abbott, Steven Katz
1School 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. mfcostello@unsw.edu.au
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.
