Ketorolac-mepivacaine lower uterine block for in-office endometrial ablation: a randomized, controlled trial.

OBJECTIVE: To investigate the effectiveness of a nonsteroidal antiinflammatory drug (NSAID) administered in combination with a local anesthetic as a deep paracervical block for in-office endometrial ablations. STUDY DESIGN: Double-blind, placebo-controlled, randomized trial. Patients received either sublingual ketorolac (30 mg/1 mL) or a mepivacaine-only paracervical injection (standard group) or received sublingual saline (1 mL) and a ketorolac (30 mg/1 mL)-mepivacaine paracervical block (NSAID group)for Gynecare Thermachoice III ablation (Ethicon, Inc., Somerville, New Jersey). All received sublingual ketorolac/placebo and 1 mg alprazolam sublingually 20 minutes preprocedure. Primary outcome was intraoperative pain control measured by 100 mm visual analogue scale. Secondary outcomes were postablation pain control (visual analogue scale [VAS]), postoperative use of narcotic analgesics and patient satisfaction in the first 24 hours (not satisfied, satisfied or very satisfied). RESULTS: Twenty patients were randomized into each group. No statistically significant difference was noted in overall intraoperative VAS score (p = 0.81), but there was a significant reduction in postoperative VAS (p = 0.01). There was less need for postoperative analgesic use in the first 24 hours (p = 0.02) in the NSAID group. More patients were "very satisfied" in the NSAID group. CONCLUSION: Injectable ketorolac-mepivacaine anesthetic solution functions well as a deep paracervical block for in-office gynecologic procedures, with better postoperative pain control than mepivacaine-alone protocols.

In-office endometrial ablation and clinical correlation of reduced menstrual blood loss and effects on dysmenorrhea and premenstrual symptomatology.

OBJECTIVE: To evaluate in-office Thermachoice III endometrial ablation on subsequent dysmenorrhea and premenstrual mood symptoms in relation to decreased menstrual blood loss. STUDY DESIGN: The study conducted was in a prospective cohort single group. Ablations were performed on 148 patients under parametrial block using dilute mepivacaine and oral anxiolysis for a diagnosis of menorrhagia. The primary endpoint was eumenorrhea or less, with secondary endpoints of dysmenorrhea reduction and premenstrual symptom alleviation. Patients were evaluated at 3 and 6 months postprocedure. Of 148 patients, 134 (90.5%) complied with follow-up. RESULTS: At 3 months, 52% were amenorrheic; 48% reporting hypomenorrhea. Results persisted at 6 months, with 50% and 48%, respectfully. Of 134 patients, 3 were considered nonresponders at 6 months. Mean hemoglobin values increased for all groups at each time endpoint. Of 115 patients, 79 reported baseline dysmenorrhea, with improvement in visual analog scale findings at both 3 and 6 months (p<0.005). Premenstrual mood symptoms of agitation, irritability and depression also improved at both 3 and 6 months. CONCLUSION: In-office Thermachoice III endometrial ablation results in decreased dysmenorrhea and improved mood in relation to decreased menstrual blood loss.

In-office endometrial ablation using a third-generation uterine balloon therapy system: 12-month prospective follow-up on menstrual patterns and dysmenorrhea impact.

OBJECTIVE: To evaluate the efficiency of in-office Thermachoice III (Ethicon, Somerville, New Jersey) endometrial ablations in resolving menstrual abnormalities as well as dysmenorrhea at 12 months after the procedure. STUDY DESIGN: This was a prospective, single arm, cohort study of women from an inner city, community based, physician group medical/ surgical clinic. Diagnostic hysteroscopy, dilation and curettage, and Thermachoice III endometrial ablation were performed under local analgesia. RESULTS: At baseline, N = 148. At 12 months, 23 patients were lost to follow-up, leaving 125 for the evaluable cohort. The largest resulting patient category was amenorrhea, with 66.4% (83 of 125 evaluable), followed by hypomenorrhea at 31% (39 of 125 evaluable). Three patients (2.4%) were considered clinical failures. These 3 patients initially were designated as having hypomenorrhea at 3 months. Dysmenorrhea reduction was statistically significant (p < 0.05) at 6 months and 12 months as compared to baseline. CONCLUSION: At 1 year after the procedure, the efficiency of in-office Thermachoice III was observed, with high amenorrhea rates as well as persistently decreased dysmenorrhea.