Treatment of menorrhagia associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

Menorrhagia is an increasingly common health problem. The Icvonorgestrel-releasing intrauterine system [LNG-IUS] has been advocated for the treatment of menorrhagia as an alicrnativc to surgery. Based on this established indication and theoretical potential of targeted endometrial solution of myoma-related bleeding, we evaluated the efficiency of LNG-IUS in treating selected cases presenting with menorrhagia in the presence uicrinc leiomyomas. This study included 68 patients with history of menorrhagia and U/S proved submucous uterine leiomyoma. Uterine bleeding was done by the semiquantitative pictorial blood loss assessment score [PBAC]. The 5-Dimensional EuroQol [EQ-5D] was chosen as the primary measure of effectiveness on health-related quality of life. Patients were re-evaluated at 3,6,9 and 12 month. Alter 12 months of follow-up, a significant reduction of menstrual flow was observed up to amenorrhea [in 11 cases]. No significant effect for the ENG-IUS on the volume of fibroids or the uterine volume was observed. A significant improvement of the quality of life [measured by EQ index] was observed. Side effects were reported in 10 cases. Eight eases required removal of the IUD for different reasons. So this study shows that in selected cases of uterine leiomyomas, LNG-IUS is an effective therapy directed towards the local steroid environment of the endometrium for control of the bleeding with no valuable effect on the myomas themselves

effect of intraabdominal instillation of lidocaine during gynecological laparoscopic procedures

Although laparoscopic surgery is known to cause less postoperative pain when compared to laparotomy, some patients still suffer from excessive pain, especially during the first stages of recovery. The purpose of this study was to assess the effect of intraperitoneal instillation of lidocaine during gynecological laparoscopic procedures on postoperative pain. The study was a prospective, randomized, double-blinded, placebo-controlled trial. This study included 75 patients who underwent gynecological laparoscopic procedures at Women Hospital - Kusr Al-Aini. Patients were randomly assigned either to a study group that received 120mg of lidocaine intraperitonealy at the end of surgery [n=60] or to a control group that received normal saline [NS] in the same manner [n=15]. The fluid was injected with a sterile syringe through one of the laparoscopy ports at the end of surgery. All patients received the same anesthetic technique. Postoperative pain was evaluated according to postoperative analgesic requirements and by Wong-Baker FACES Pain Rating Scale [WBFS] at 15min, 1h, 2h, 4h, 12h and 24h postoperatively. The [WBFS] score was found to be lower for the study group 1h, 2h and 4h after surgery [p=0.023]. There was no difference in the [WBFS] scores at 15min [p=0.9], 12h [p=0.13] and 24h [p=0.11] after surgery. There was no difference in terms of fentanyl administration during surgery or analgesic consumption following surgery between the study and control groups. The results indicated that intraperitoneal installation of lidocaine was effective at reducing postoperative pain and the need for postoperative analgesics following gynecologic laparoscopic procedures