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.