A prospective, randomized, double-blind, placebo-controlled trial of multimodal intraoperative analgesia for laparoscopic excision of endometriosis

ObjectiveTo assess the efficacy of multimodal intraoperative analgesia in reducing postoperative pain and/or opioid requirements in women undergoing laparoscopic excision of endometriosis.DesignProspective, randomized, double-blind, placebo-controlled trial.SettingEndogynecologic 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.