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Saturday, June 21, 2014

Trailers (86): Reducing postoperative pain after tubal ligation

Harrison et al. Reducing postoperative pain after tubal ligation with rings or clips: a systematic review and meta-analysis

Why should you read about this topic?

Postoperative pain control is a major driver of patient satisfaction

What were the authors trying to do?

Estimate the efficacy (pain control) of local anesthesia applied to the fallopian tubes during laparoscopic sterilization with rings or clips under general anesthesia.

Who participated and in what setting?

Published reports (N=20) of women (N=1095) participating in randomized, double-masked, placebo-controlled trials of topical or injectable local anesthetic applied to the fallopian tubes to reduce pain at laparoscopic sterilization.

What was the study design?

Systematic review and meta-analysis

What were the main outcome measures?

Pain scores

What were the results?

Postoperative pain decreased with the use of local anesthetic compared with placebo by 11.9-18.6 mm (VAS) and by at least 33% in the first 8 hours, with greater benefit going to those patients receiving sterilization by rings.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: thoughtful, pre-specified subanalyses; results stratified for risk of bias.   Weaknesses: no recent primary studies

What does the study contribute for your practice?

Local anesthetic applied to the fallopian tubes when sterilized with rings or clips by laparoscopy yields lower pain scores in the first 8 postoperative hours.