According to a new research, adding a paracervical block to general anesthesia for endometrial ablation reduces pain and the need for postoperative narcotics.
Dr. Jordan S. Klebanoff of Christiana Care Health System in Newark reported, "Our study showed that women who received a paracervical block at the completion of their endometrial ablation had less pain at one hour postoperatively. In addition, less immediate postoperative narcotic medication was required."
"Options for controlling pain, such as adjunct local anesthetic blocks, may help decrease the need for narcotics postoperatively. Given the opioid epidemic that we as a nation are facing, taking this measure can help protect our patients from opioid addiction," said Dr. Nima R. Patel, of Christiana Care Health System.
Dr. Klenaboff et al. report data from 82 premenopausal women (age 30-55) undergoing endometrial ablation for benign disease at one community hospital. In this randomized trial, participants were assigned to post-ablation paracervical injection of either 20 mL 0.25% bupivacaine or 20 mL normal saline.
As reported online in the American Journal of Obstetrics & Gynecology, visual analog scale pain scores were significantly lower in the bupivacaine group than the control group 1 hour after the procedure (mean, 1.44 vs. 2.71), but the difference was no longer significant at 4 hours or 8 hours. The bupivacaine group patients also used significantly less pain medication after surgery.
Dr. Tatnai L. Burnett of Mayo Clinic in Rochester, Minnesota reported, "Any additional method of decreasing postoperative pain is welcomed, and this is another tool in the toolbox for gynecologists to keep their patients comfortable after minor procedures such as this."
"The randomized nature of this study lends to its strength, and the overall design was fairly well done with no catastrophic flaws. I appreciate that the authors measured home narcotic medication use," said Dr. Burnett, who was not involved in the study.
"A validated measure of patient satisfaction with pain relief would have strengthened the study further, allowing us to understand if these minor differences measured between the groups were of any real value to the patient," he suggested.
Dr. Jimmy Espinoza of Baylor College of Medicine in Houston, Texas, who also was not involved in the study, said that prescribed narcotic medications have contributed greatly to the recent opioid abuse and addiction epidemic.
"This study could potentially change postoperative pain management following endometrial ablation by demonstrating that local analgesia can reduce exposure to opioid medications," he noted.
"This study provides level 1 evidence that local anesthesia can improve pain control in the immediate postoperative period following endometrial ablation. The study was done at a single institution and requires replication in a multicenter study to determine if the findings can be replicated and (are) generalizable to the whole population," Dr. Espinoza said.
"The benefit of local analgesia was only on the immediate (postoperative) period (first hour) but not four or eight hours after surgery. This is most likely due to the short elimination half-life of the bupivacaine (2.7 hours). Other forms of bupivacaine have longer half-lives, including liposomal bupivacaine, which is used for transverse abdominis plane (TAP) block following cesarean section," he added.