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Obstetrics & Gynecology 2004;104:243-249
© 2004 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Bupivacaine Plus Epinephrine for Laparoscopic Myomectomy: A Randomized Placebo-Controlled Trial

Fulvio Zullo, MD*, Stefano Palomba, MD*, Domenico Corea, MD*, Massimiliano Pellicano, MD, PhD{dagger}, Tiziana Russo, MD*, Angela Falbo, MD*{dagger}{ddagger}§, Ermanno Barletta, MD*, Pasquale Saraco, MD{ddagger}, Patrizia Doldo, MD§ and Errico Zupi, MD

From the *Department of Obstetrics and Gynecology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy; {dagger}Department of Obstetrics and Gynecology, University of Naples "Federico II," Naples, Italy; {ddagger}Unit of Anesthesiology, "Pugliese-Ciaccio" Hospital of Catanzaro, Catanzaro, Italy; §Department of Experimental and Clinical Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy; and ¶Department of Obstetrics and Gynecology, University "Tor Vergata" of Rome, Rome, Italy.

Address reprint requests to: Dr. Stefano Palomba, Via Nicolardi 188–80131 Naples, Italy; e-mail: stefanopalomba{at}tin.it.

OBJECTIVE: To evaluate the effectiveness of the injection of bupivacaine plus epinephrine before laparoscopic myomectomy.

METHODS: Sixty premenopausal women with uterine leiomyomata were enrolled in a randomized controlled design and intraoperatively treated with injection of bupivacaine plus epinephrine (group A) or saline solution (group B) during laparoscopic myomectomy. Uterine size and volume, number of leiomyomata, hematological parameters, total operative time, enucleation time of each myoma, suturing time of the myomectomy, blood loss, degree of surgical difficulty, and postoperative pain were evaluated. Just before and after the injection of vasoconstrictive or saline solution, systolic and diastolic blood pressure and heart rate were recorded in each subject.

RESULTS: Blood loss, total operative and enucleation time, and degree of surgical difficulty was significantly (P < .05) lower in group A than in group B. No difference was observed between groups in suturing time of the myomectomy. The number of vials of pain medication used postoperatively was significantly (P < .05) lower in group A than in group B. No differences in systolic and diastolic blood pressure or heart rate was recorded between the 2 groups.

CONCLUSION: The injection of bupivacaine plus epinephrine during laparoscopic myomectomy is effective in reducing blood loss, total operative and enucleation time, degree of surgical difficulty, and postoperative pain.

LEVEL OF EVIDENCE: I






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