Effects of ketoprofen and mesosalpinx infiltration on postoperative pain after laparoscopic sterilization.

OBJECTIVE: To determine whether preoperative ketoprofen and mesosalpinx infiltration, either alone or in combination, favorably influence postoperative recovery after outpatient laparoscopic sterilization.

METHODS: In a double-blind, randomized, placebo-controlled study, 20 women received 100 mg of oral ketoprofen preoperatively, and each mesosalpinx was infiltrated with 5 mL of saline plus epinephrine 1:200,000; 20 women 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 assessed by a visual analogue scale and a self-assessment 11-point scale; outcome was assessed by discharge time, consumption of analgesics, incidence of nausea and vomiting, and the number of postoperative days to full recovery.

RESULTS: Pain ratings in the ketoprofen-only group were significantly higher than in the two other groups (P < .001). Preoperative ketoprofen alone provided insufficient postoperative pain relief, necessitating the use of opiates and peripheral analgesics. Nausea and vomiting were highest in these subjects, as was intake of peripheral analgesics at home. Times to discharge were also the longest in this group (median 385 minutes, range 260-510) and differed significantly 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 minutes, range 105-375). Recovery usually occurred by the fourth postoperative day. The combination of preoperative ketoprofen and mesosalpinx block resulted in the shortest times to discharge (median 190 minutes, range 80-330), the least consumption of peripheral analgesics, and the lowest incidence of nausea and vomiting. Recovery occurred by the fourth postoperative day.

CONCLUSION: Mesosalpinx infiltration has a favorable effect on postoperative recovery after day-surgery laparoscopic sterilization. Still better results can be obtained with a multimodal analgesic approach, combining mesosalpinx infiltration with preoperative ketoprofen.