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

OBJECTIVE To assess the effectiveness of using local anesthesia during interval laparoscopic tubal ligation to control postoperative pain. DATA SOURCES We searched MEDLINE, PubMed, and Cochrane databases and found additional articles from bibliographies of relevant studies. METHODS OF STUDY SELECTION We included only randomized, double-blind, placebo-controlled trials reporting postoperative pain after interval laparoscopic tubal ligation under general anesthesia (n=20). The trials compared the application of topical or injectable local anesthetic with placebo and used a visual analog scale (VAS) (scores 0-100) or the Modified McGill Pain Intensity Scale (subsequently converted to a VAS) to assess pain. TABULATION, INTEGRATION, AND RESULTS Pain scores were evaluated at the following times after extubation: 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, and 24 hours. The meta-analysis was based on random-effects methods for pooled data using RevMan. Postoperative pain decreased with the use of local anesthetic compared with placebo as follows (mean VAS decrease in millimeters, 95% confidence interval): 30 minutes 18.6 (11.7-25.5); 1 hour 16.6 (9.3-24.0); 2 hours 17.4 (9.6-25.2); 4 hours 12.5 (5.1-19.9); 8 hours 11.9 (6.7-17.1); and 24 hours 3.9 (-1.4 to 9.2). There was moderate heterogeneity in the data across studies (I statistic ranging from 55% to 75%). The effect size was similar for the following subgroups: pain scores reported as means or medians and use of McGill compared with VAS pain scales. A stratified analysis of trials including ring tubal ligation compared with clip tubal ligation showed the use of local anesthetic decreased pain substantially for both. No eligible studies assessed tubal ligation with cautery. CONCLUSION Use of local anesthetic during laparoscopic tubal ligation substantially reduces postoperative pain up to 8 hours after surgery.