RESUMO
BACKGROUND: Tubal ligation (TL) is the most popular method of permanent contraception. In order to reduce postoperative pain, different analgesic techniques have been proposed. The objective of this study was to compare the level of postoperative pain in patients submitted to TL with electrocoagulation, under general anesthesia, using bupivacaine infiltration vs. placebo in trocar ports. STUDY DESIGN: Consecutive patients scheduled for laparoscopic TL were randomized by sequenced coded envelopes to receive bupivacaine 0.5% (n=29) or placebo (n=24). Pain was blindly assessed at 15 min, 30 min, 120 min and 14 h postoperatively, by verbal analogue scale (VAS). Standard pain medications (morphine, dipyrone and sodium diclofenac) were prescribed for the subjects and compared between groups. RESULTS: No difference in pain assessment was found between bupivacaine and placebo groups at all times [median (25-75 quartiles)] (all p>.05): 15 min: 3 (1-6.3) vs. 4 (0-7); 30 min: 1.5 (0-4.3) vs. 2 (0-5); 2 h: 0 (0-0.5) vs. 0 (0-1); 14 h: 1 (0-4) vs. 0 (0-4); and for use of analgesics: dipyrone (g): 1 (0-1) vs. 1 (0-1); morphine (mg): 3 (0-3) vs. 3 (0-3.5); sodium diclofenac (mg): 0 (0-50) vs. 0 (0-50). CONCLUSION: The use of local injection of bupivacaine 0.5% in the trocar ports was not superior to placebo to reduce pain after laparoscopic TL with electrocoagulation under general anesthesia.
Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Eletrocoagulação , Laparoscopia/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Esterilização Tubária/métodos , Adulto , Analgésicos Opioides/administração & dosagem , Anestesia Local/métodos , Anti-Inflamatórios não Esteroides/administração & dosagem , Método Duplo-Cego , Quimioterapia Combinada , Tubas Uterinas/cirurgia , Feminino , Humanos , Injeções Subcutâneas , Laparoscópios/efeitos adversos , Medição da Dor , Fatores de TempoRESUMO
Abdominal wall bleeding may complicate any laparoscopic procedure. Piercing or laceration of vessels transversing the abdominal wall during trocar placement is generally the cause. Bleeding may occur at the very beginning of the surgery but, in some cases, it may go unrecognized for a while complicating the operation and the postoperative course. Planned and careful trocar placement can prevent most of these instances that otherwise can be readily managed avoiding severe morbidity.