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34 9

V. K im Co mf ort MD, W il l iam E. C ode MD FRCPC,M icha el E. Ro on ey BSP, R.W . Yip Mr) FRCPC

N aproxen p rem edicationreduces postoperativetubal l igat ion painThis s tudy eva lua ted the e f f ec t iveness o fna prox en sod ium ora lpremedica t ion in reduc ing pos topera t ive pa in , ana lges ic re -qu irements an d day surg ery l eng th o f s tay in pa t ien t s undergo ingoutpa tient laparoscop ic tubal l igations. We undertook a random -ized , doub le -b l ind c l in ica l tr ia l on ASA I and ASA H pa t ien t sunderg oing outpatien t laparos copic tubal l igations. The treat-men t group rece ived two capsu les con ta in ing naproxen sod ium,275 mg each , and the con tro l group rece ived two iden t ica lcapsu les con ta in ing p lacebo . Pos topera t ive v i sua l ana loguepa in scores , ana lges ic requ irements , s ide -e f fec t s and leng th o fday surgery s tay were s tud ied . For ty - four pa t ien t s comple ted thes tudy wi th 21 pa t ien t s in the naproxen group and 23 in thep lacebo group . There was a s ta t i s ti ca l l y s ign i f i can t d i ff e rencebe tween groups in t e rms o f pa in score (naproxen group 0 .9 +-0 .2 vs p lacebo group 3 .5 +- 0 .6) ; pa t ien t s requ ir ing pos t -opera t ive op io ids (naproxen group 0% vs p lacebo group 34 .8% );and t ime spen t in the day surgery un i t (naproxen group 168 -+ 13rain vs placebo grou p 188 +-- 15 rain). There w as no d i f ferenc e inthe inc idence o f nausea and vomit ing . Only one person deve l -oped a s ide -e f f ec t f rom the naproxen sod ium w hich was minorgas t r ic d i scomfort . Th i s s tudy shows tha t naproxen decrea sed thepos topera t ive tuba l l iga t ion pa in wi th l e ss subsequen tpos topera t ive ana lges ic requ irements , l e ss t ime to s t ree t i tnessam ino increase in ana lges ic s ide -e f f ec ts . We recom mend the useo f th i s premed ica t ion in ou tpa t ien t laparoscop ic tuba l l iga t ions.Le bu t de la prgsen te d tude g ta i t de dg terminer s i l e naproxensod ique donnd avan t une l iga ture tuba ire par laparoscop iedimin uait la douleur, les besoins analgg siques et le s~jour

K e y w o r d sANAESTHESIA: outpa tien t;ANALGESICS:naproxen;PAIN: pos tope rat iv e;PREMEDICATION.From the Department of A naesthesia, Royal University H ospi-tal, Saskatoon, Saskatchewan, S7N 0X0.

Address correspondence to : Dr. V. K im Comfort, Depart-ment o f A naesthesia, Royal University H ospital, Saskatoon,Saskatchewan, S7N 0X 0.

Accep ted fo r pub l ica t ion 27 th December , 1991.

hosp ital ier postopg ratoires. Da ns cet te dtude gt double insu, 44pa t ien tes ex ternes avec un d ta t phys iqu e ASA I ou H on t d tdrdpar t ie s de fa~on a lda to i re en un group e t ra i t ement (n = 21)et un group e contrOle (n = 23). Le s patientes trai tdes (groupeN) on t pr i s deux compr imds de naproxen sod ique de 275 mg aumoins une heure avan t la ch i rurg ie a lors que ce l l e s du groupecontrOle (groupe C ) on t re~u deux compr imds de m#m e format ,mais con tenan t un p lacebo . L es param ~tres #valuds compre-na ien t la dou leur pos topgra to i re dd terminde par dche l leanalog ue visuel le , les besoins analgdsiques, les ef fets secon -da ires, a ins i que la durde du sd jour en sa l l e de rdve i l e t dansl 'un i tg de ch i rurg ie d 'un jour . Les rdsu l ta t s on t ddmontrd desd i f fgrences s ign i f i ca t ives en t re l e s groupes pour l e ddcomptel '#chelle de la dou leur (0, 9 +- O,2 pour l e groupe N versus 3 , 5 +-0 ,6 pour l e groupe C) , l e nombre de pa t ien tes ndcess i tan t desnarco t iques aprbs la ch i rurg ie (0% dar t s l e groupe N versus34 ,8% dans l e groupe C) , e t la durge du sd jour dans l 'un i tg dech irurg ie d ' un jou r (168 -+ 13 ra in pou r l e groupe N versus 188+- 15 min pour l e groupe C) . L ' inc idenc e de nausges e t vomisse -ments d ta i t comparab le en t re l e s groupes . U ne seu le pa t ien te aprdsentd une rdaction au naproxen sodique, soi t un lggerbrdlem ent dpigastrique. Cette ~tude d~montre que le napro xend iminue la dou leur , l e s beso ins ana lgds iques e t l e sd jourhosp i ta l i e r pos topdra to i re apr~s l iga ture tuba ire par laparosco-p ie . Nous recomm andons un e pr~mddica t ion avec naproxen pou rcette chirurgie.

T h e g o a l s o f o u t p a t i en t a n a e s th e s i a a r e t o p r o d u c e m i n i m a lre s idua l e f fec t s , goo d ana lges ia and a qu ick re tu rn to s t ree tf i tnes s . To accom pl i sh th i s , anaes the t i c d rugs need to beshor t ac t ing wi th m in im a l s ide -e f fec t s . In add i t ion , ana l-g e s i cs s h o u l d h a v e a n a p p r o p r i a te d u r a t i o n o f a c t i o n y e tp r o d u c e m i n i m a l s e d a t i o n . P o s t o p e r a t i v e p a i n c a n b e am a j o r d e t e r m i n a n t i n t h e r e c o v e r y t i m e o f p a t i e n ts u n d e r -go ing l apa ro scopic tuba l l iga t ion . I Th i s pa in i s be l i eved tor e s u lt f r o m p r o s t a g la n d i n r e l e a s e d f r o m t h e t r a u m a t i z e dF a l lop ian tube , which l eads to u te r ine con t rac t ion and ac r a m p - l i k e l o w e r a b d o m i n a l p a i n . 2 T h e r e f o r e , p r o s t a -g land in inh ib i t ion by the nons te ro ida l an t i - in f l am m atoryd r u g ( N S A I D ) n a p r o x e n s o d i u m s h o u l d r e d u c e t h e p e l v icp a i n e x p e r i e n c e d b y t h e s e p a t i e n ts a f t e r s u r g e r y . N a p r o x e ns o d i u m h a s b e e n f o u n d t o b e e f f e c t i v e i n t h e t r e a tm e n t o fm e n s t r u a l c r a m p s i n o r a l d o s es o f 5 0 0 m g e v e r y s i x

CAN J A NA ESTH 1992 / 39 :4 / pp. 349-52

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35 0 CANADIAN JOURNAL OF ANAESTHESIAhour s . 3 I dea l ly , the i r use wou ld l ead to r educ ed op io idr equ i r em ents and a dec r eased leng th o f s t ay in the daysur ge r y un i t .

Th is s tudy was des igned to eva lua te the r o le o f o r a ln a p r o x e n s o d i u m 5 5 0 m g i n r e d u c in g p o s t o p e r a t i v e p a i n ,a n a l g e si c r e q u i r e m e n t s a n d d a y s u r g e r y r e c o v e r y t im e .Method sAf te r ins t i tu tiona l e th ic s appr ova l , a random ized , doub le -b l in d , p r o s p e c t i v e s t u d y w a s c o n d u c t e d w i t h c o n s e n t i n gAS A I and I I pa t i en t s under go ing ou tpa t ien t l apa r oscopictuba l l iga t ion und er gene r a l anaes thes ia . P a t ien t exc lus ionc r i t e r i a inc luded a l l e r g ie s to NS AI Ds , h i s to r y o f pep t icu lce r d i s ease , and b leed ing d i sor de r s . P a t ien t s r ece ivedtwo iden t ica l capsu les cons i s t ing o f e i the r p lacebo orn a p r o x e n s o d i u m 2 7 5 m g ( t o t a l d o s e 5 5 0 m g ) n o l e s s t h a no n e h o u r b e f o r e o p e r a t i o n .

Th e pe r iope r a t ive op io id adm in is t r a t ion was con t r o l l ed .N o o p i o i d s w e r e g i v e n f o r p r e m e d i ca t i o n . D u r in g a n a e s -thes ia f en tany l ( 2 I xg ' kg - I ) o r a l f en tan i l ( 20 p , g . kg - 1)wer e ad m in is te r ed on ly a t induc t ion of anaes thes ia . P os t -o p e r a t i v e a n a l g e s i a w a s g i v e n o n d e m a n d b y n u r s e ' sa s ses sm ent o f pa t i en t ' s pa in , l eve l o f consc iousnes s andvi ta l s igns . I t took the f o r m of pa r en te r a l m or phine o rd e m e r o l o r o r a l a c e t a m i n o p h e n w i t h o r w i t h o u t c o d e i n e .I nduc t ion and m a in tenan ce anaes the t ic agen ts wer e a t thed i sc r e t ion of the a t t end ing anaes the t i s t .

P a i n s c o r e s ( P S ) w e r e m e a s u r e d b y V i s u a l A n a l o g u eS c o r e4 p r e o p e r a t i v e l y ( P S O ) a n d a t o n e ( P S I ) a n d t w o( P S 2) hou r s a f te r the s tar t o f the p r ocedur e . P a t ien t s wer et h e n f o l l o w e d u p b y t e l e p h o n e t h e n e x t d a y . T h e P S O w a sze r o in a l l bu t one pa t ien t , P S 1 r e f lec ted the im m ed ia tepos top e r a t ive pa in p r io r to ana lges ic s and w as f e l t apriorit o b e t h e m o s t r e l ia b l e t im e t o m e a s u r e n a p r o x e n ' s p o t e n -t i a l e f f i cacy , conf o und ed the l eas t by s ign i f i can t r e s idua lanaes the t ic e f f ec t s and be f or e supplem enta l ana lges ic s .Th e P S 2 r e f lec ted pa in a f te r ana lges ic s wi th the r e s idua le f f ec t s o f the anaes the t ic be ing m in im ized . Al l op io id an do t h e r an a l g es i c u se was r eco rd ed as were ep i so d es o fn a u s e a a n d v o m i t in g .D a t a w a s a n a l y z e d b y t h e W i l c o x o n R a n k S u m t e s t f o rc o m p a r i s o n o f p a i n s c o r e s b e tw e e n t h e t r e a tm e n t g r o u pand the con t r o l g r oup . The ind epende nt t t e s t was used toa n a l y z e r e c o v e r y a n d d a y s u r g e r y t i m e s b e t w e e n g r o u p sand the ch i squa r e t e s t wi th Ya tes ' co r r ec t ion was used toa n a l y z e d i f f e r e n c e s b e t w e e n g r o u p s i n r e g a r d s t o d e m o -gr aphic da ta , nausea /vom i t ing and com pl ica t ions . A Pva lue o f < 0 . 05 was cons ide r ed s ta ti s t i ca l ly s ign i fi can t . Al ldata we re rec ord ed w ith ___ SEM .Resul t sF i f ty - n ine pa t ien t s wer e appr oac hed to en te r the s tudy . S ixd e c l i n e d f o r p e rs o n a l r e a s o n s a n d s i x w e r e e x c l u d e d f o r

TABLE I Demographic dataTreatment Controlgroup group

Age (yr) 31 m 1.2 30 -+ 1.3Weig ht (kg) 65.4 3.3 68.6 2.9Menses 4 (19.0%) 1 (4.3%)OralContraceptives 4 (19.0%) 7 (32.3%)Felsche clips 6 (28.6%) 7 (32.3%)Mean procedureDuration (rain) 46 -+ 4 43 -+ 3Associated procedures 5 (24%) 0 (0%)

NSNSNSNSNSNSP < 0.05

NS = nonsignificant.

TABLE II Visual analogue pain scoresTreatment Controlgroup group

Pain Score 1 hr 0.9 --- 0.2 3.5 --- 0.6 P < 0.05(PSI) n=21 n=2 3Pain Score 2 hr 1.1 +-- 0.2 2.4 __. 0.5 P < 0.05(PS2) n = 21 n = 23Pain score 0.2 -+ 0.1 0.6 -+ 0.2 NSnext day n = 17 n = 16PSI 0.6- +0. 3 4.91 " 1.2 P< 0. 01Clips n = 6 n = 7PSI 1.0 -+ 0.3 1.7 --+ 0.5 P < 0.05Coagulat ion n = 15 n = 16

m edica l r easons ( ac t ive pep t ic u lce r d i s ease ) so tha t 47pa t ien t s wer e en te r ed . Th r ee pa t ien t s wer e exc lude d f r omf i n a l a n a l y s i s : t w o p r o c e e d e d t o l a p a r o t o m y a n d o n eexper ienced a s eve r e psycholog ica l r eac t ion a s soc ia tedw i t h a c o n c o m i t a n t t h e r a p e u t i c a b o r t i o n . T w e n t y - o n ep a t ie n t s w e r e r a n d o m i z e d t o t h e n a p r o x e n g r o u p a n d 2 3 t othe p lacebo gr oup .

D e m o g r a p h i c i n f o r m a t i o n ( T a b l e I ) r e v e a l e d n o d i f f er -e n c e s b e t w e e n t h e g r o u p s . P o s s i b l e c o n f o u n d i n g v a r i a b l e ssuch a s m enses a t the t im e of sur ge r y , the use o f o r a lcon t r acep t ive p i l l s ( OCP ) , pe r cen tage hav ing F e l schec l ips ve r sus coagula t ion , and the p r ocedur e l eng th , wer en o t d i f f e re n t b e t w e e n t h e g r o u p s . T h e n u m b e r o f p a t i e n t sh a v i n g a s s o c i a te d p r o c e d u r e s p e r f o r m e d a t t h e s a m e t i m eas the tuba l l iga t ion was g r ea te r in the napr o xen gr ou p thani n t h e p l a c e b o g r o u p . T h e s e p r o c e d u r e s i n c l u d e d o n ed i la t ion and cur r e tage , th r ee r em ova l o f in t r au te r inec o n t r a c e p t i v e d e v i c e s a n d o n e l a s e r t h e r a p y o f p l a n t a rwar t s in the t r ea tm ent g r oup .

Visua l ana logu e scor es , wi th ze r o be ing no pa in and tenb e i n g e x t r e m e p a in , f o r o n e h o u r p o s t ( P S I ) w e r e m a d e a ta n a v e r a g e o f 6 1 m i n f r o m t h e s t a r t o f t h e p r o c e d u r e inbo th g r oups and two hour s pos t ( P S 2) 132 m in in then a p r o x e n g r o u p a n d 1 3 0 m i n i n t h e p l a c e b o g r o u p ( T a b l eI I ) ( NS ) . As can be s een in Tab le I I , the t r ea tm en t g r oup

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Comfor te tal . : N A P R O X E N P R E M E D I C A T I O N 351T A B L E I I I P os t ope r a t i ve op i o i d t he r a py

Treatment Controlgroup group

P a t i e n t s r e qu i r i ng1 P os t ope r a t i ve pa r e n t e r a l 0 8 ( 34 . 8% ) P < 0 . 05

o p i o i d s2 Int rahosp i ta l ana lg esia 3 (14.3% ) 12 (52.2% ) P < 0.053 P os t - d i s c ha r ge a na l ge s i a 7 ( 41 . 2% ) 9 ( 50 . 0% ) N S

n = 1 7 n = 1 8

T A B L E I V R e c o v e r y r o o m an d d a y s u r g er y s t ayTreatment Controlgroup group

M ean tim e (rain) 47 3 50 ___ 5 NSi n r e c ove r y r o o mM e a n t i me ( mi n ) 168 13 188 _ 15 P < 0 . 0 1

i n da y su r ge r y

had l ow er pa i n sco res pos t opera t i ve l y a t bo t h PS 1 andPS2 . When t he g roups were d i v i ded i n t o subgroups o ft hose r ece i v i ng Fe l sche c l i p t uba l occ l us i on and t hoserece i v i ng coagu l a t i on , the pa i n sco res were l ow er i n t henap roxen g roup fo r bo t h t echn iques . In t he p l acebo g roupt he pa i n sco res w ere h i gher i n t hose hav i ng Fe l sche c l i p st han coagu l a t i on (P < 0 .05) .

T h e n u m b e r o f p a ti e n ts w h o c o u l d b e c o n t a c t e d t he n e x tday was no t d i f f e r en t be t ween g roups (Tab l e I I ) . Pa i nsco res had r eg ressed t o m i n i mal l eve l s i n bo t h g roups bythis t ime.

The r equ i r emen t fo r paren t era l op i o i ds (Tab l e I I I ) wasl ower i n t he nap roxen g roup wi t h no pa t i en t r equ i r i ngparentera l opioids. In cont rast , 34 .8% of the pat ients in thep l acebo g roup r ec e i ved paren tera l op i o i ds. Com par i son o fi n t r ahosp it a l o r a l ana l ges ic r equ i r emen t s was a l so l ess i nt he nap roxen g roup . There was no d i f f e r ence be t weengroups i n t he u se o f pos t -d i scharge ana l ges ics .

On l y one pa t i en t i n the nap roxen g roup ha d a s i de-ef f ec ta t t r i bu t ab l e t o t he nap roxen sod i um, namel y mi l dep i gas t r i c bu rn i ng i mmed i a t e l y befo re opera t i on . Af t e rsu rgery , fou r pa t i en t s (19 .0%) i n t he nap roxen g roupexper i enced na usea / vom i t i ng ver sus f i ve pa t ien t s (21 .7%)in the p lacebo group (NS) .

A l t h o u g h t h e m e a n t im e s p e n t in t h e r e c o v e r y ro o m w a sno t d i f f e r en t be t wee n g roups (Tab l e IV ) , a sho r t e r t i mewas spen t i n t he day su rgery un i t pos t opera t i ve l y by t hosei n t he nap roxen g roup (P < 0 .01 ).Di s cus s i onTubal l i ga t i on i s assoc i a t ed wi t h cons i derab l e pos t -opera t i ve pa i n I wh i ch l eads t o pa t i en t d i scomfor t , nauseaand vo mi t i ng , and de l ay ed r ecovery . Th i s pa i n i s r e l a t i ve ly

b r i e f and r eso l ves i n m os t pa t i en t s wi t h i n 24 h r. 5 Hua nge t a l . e x a m i n e d t h e e f f ic a c y o f th e N S A I D m e c l o f e n a m a t ep reme d i ca t i on i n pa t ien t s undergo i ng l aparoscop i c t uba ll i ga ti on and de mon s t r a t ed a decrease i n pos t opera t ive pa i n ,a l be i t o f sho r t du ra t i on due t o t he sho r t ha l f - l i fe o f t h i sd rug . However , i n t he i r s t udy t here was no men t i on o fcon t ro l o f concu r ren t op i o i d admi n i s t r a ti on . Loca l anaes -t hes i a i n f i l tr a t i on o f t he t ubes i n t r aopera t i ve ly has a l sobeen show n t o be e f f ec t i ve i n r educ i ng pos t opera t ive pa i n6but th i s i s al so of shor t durat ion (up to two hours) . Na-p r o x e n s o d i u m h a s b e e n c o m p a r e d w i t h a c e t a m i n o p h e nand pen t azo c i ne fo r pos t opera ti ve pa i n i n a w i de var i e t y o fsu rg i ca l p rocedures and w as foun d t o be super i o r t o bo t hi n pa i n con t ro l and pa t i en t t o l e rance .7 B r o w n e t a l . c o m -pared nap roxen so d i um wi t h morph i ne su l f a t e and p l aceboi n pos t opera t ive su rg i ca l pa i n and found nap roxen sod i umas e f f ec t i ve as mo rph i ne i n t he f i r s t hou r and super i o r t omorph i ne a t t h r ee t o s i x hour s a f t e r adm i n i s tr a t i on ,s

Naproxe n sod i um i s r ap i d l y abso rbed wi t h peak p l asmaconcen t r a t i on a t t a i ned wi t h i n 20 --40 mi n . I t has a p l asmabet a ha l f - l i f e o f app rox i m at e l y 14 h r9 wi t h a du ra t i on o fc l i n ica l ac t i on o f abou t e i gh t hou r s t ~ma k i ng i t an exce l l en tcho i ce fo r t he t r ea t m en t o f t he pa i n assoc i a t ed wi t h t h i sp rocedure . By g i v i ng t he med i ca t i on befo re su rgery ,t herapeu t i c p l asma l eve l s a r e a t t a i ned befo re t he t i s sued a m a g e w h i c h m a y r e d u c e p r o s t a g la n d i n s y n t h es i s a n dpreven t t he r esu l t i ng pos t opera t i ve pa i n . 2 Nap roxensod i um i s a non-narco t ic ana l ges i c wi t hou t t he compl i ca-t i ons o f r esp i r a t o ry dep ress i on and add i c t i on .

W e eva l ua t ed 44 pa t i en t s undergo i ng ou t pa t i en t l aparo -scop i c t uba l l i ga t i on , wi t h a b i as aga i ns t t he nap roxengroup who exper i enced more concur ren t p rocedures . Insp i te o f t h i s , pa i n wa s l ess i n t he nap roxen g roup a t bo t hme asu rem en t t imes . Th e observa t i on t ha t the pa i n exper i -e n c e d b y b o t h g r o u p s t h e n e x t d a y w a s v e r y l o w a n d n o td i f f e r en t re i n fo rces t he con cep t t ha t t h i s pa i n i s o f sho r tdu ra t i on . Pos t opera t i ve op i o i d r equ i r emen t s were r educedi n t he na p roxen g roup , e spec i a l l y fo r paren t era l narco t ics .Pos t -d i scharge ana l ges i a r equ ir emen t s w ere no t d i f f e r en tbu t o f t he seven pa t i en t s i n t he nap roxen g roup whorequ i r ed pos t -d i scharge ana l ges i a , on l y one t ook i t f o rabdomi nal d i scomfor t . The r emai n i ng sub j ec t s r equ i r edana l ges i a fo r ske l e t a l musc l e pa i n , so re t h roa t s andheadaches . In t he p l acebo g rou p seven o f the n i ne pa t i en t swho r equ i r ed pos t-d i scharge ana l ges i a t ook the m ed i ca t i onfo r abdomi na l d i scomfor t .

Our met hod o f eva l ua t i ng pos t opera t i ve pa i n u sedob j ec t i ve ana l ges i c r equ i r emen t s and sub j ec t i ve v i sua la n a l o g u e s c o re s . I n t h e m e a s u r e m e n t o f p a i n H u s k i s s o nfound t he v i sua l ana l ogue sco re t he m os t sens i t i ve o f theava i l ab l e tes t s and t h i s measu rem en t has been fo und t o bereproduc ible. 4

R e c o v e r y r o o m s t a ys w e r e n o t d i f fe r e n t b e t w e e n g r o u p s

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35 2 CANADIAN JOU RNAL OF ANAESTHESIAin th i s s tudy . Th is m ig h t be exp ec ted a s d i s cha r ge c r i t e r ia( which in ou r ins t itu te i s de te r m in ed by no le s s than n ineo n a m o d i f i e d A l d r e t e s c o r in g g u i d e ) a r e m o r e d e p e n d e n tupon r e s idua l anaes the t ic e f f ec t s . Day sur ge r y t im e wasr e d u c e d i n t h e n a p r o x e n g r o u p b y a n a v e r a g e o f 2 0 m i n ,bu t w he the r th i s cons t i tu te s a c l in ica l ly im por tan t bene f i tdepend s upo n the s i tua t ion of p r ac t i ce . Ou r c r i t e ri a f o rd i scha r ge a r e dep enden t on t im e a f te r the p r ocedu r e , l as tpa r en te r a l ana lges ic s , s t ab le v i t a l signs , pa in and vo m i t ingcont r o l and a r e a s ses sed by the nur ses a t r egu la r in te r va l s( 1 0 - 1 5 m i n ) , b u t m a y v a r y d e p e n d i n g o n t h e d e m a n d o nthe nur ses ' t im e .

N a p r o x e n s o d i u m a n d N S A I D s a r e e f f e c t i v e a s a n a l-ges ic s in ou tpa t ien t tuba l l iga t ion , a s we l l a s f o r o the r daysur ge r y p r oced ur es such a s o r tho paed ic sur ge r y 11 and intons i l l ec tom y . ~2 F ur the r s tud ies a r e r equ i r ed to e va lua ten a p r o x e n s o d i u m a n d o t h e r p r e p a r a t i o n s a s t h e o n l yana lges ic in an o p io id- f r ee anaes the t ic .

I n s u m m a r y , p r e m e d i c a t i o n w i t h o r a l n a p r o x e n s o d i u m550 m g be f or e gene r a l anaes thes ia f o r ou tpa t ien t l apa r o-scop ic tuba l l iga t ion dec r eased pa in , r educe d pos tope r a t iveana lges ic r equ i r em ents , and r ed uced the l eng th o f s t ay inthe day sur ge r y un i t wi thou t inc r eas ing m or b id i ty . Ther e -f o r e , n a p r o x e n s o d i u m i s r e c o m m e n d e d a s a n e f f e c t i v eor a l p r em edica t ion f o r pa t i en t s under go ing lapa r oscopictubal l igat ion.

8 Brow n C, Sevel ius H, Wi ld V. A com parison of singledoses of naproxen sodium, m orphine sulfate, and placeboin patients with postoperative pain. Current TherapeuticResearch 1984; 35: 511-8 .

9 Run kel R, Forchie l l i E , Boost G, e t a l . Naproxen-metab-olism, excretion and comparative pharmacokinetics. ScandJ Rheumatol 1973; 2: 29-36 .

10 Bloom fie ld S, Barden T, Mi tchel l J. Analgesic efficacy ofnaproxen in postpartum pain. Clin Pharmacol The r 1974;15: 201.

11 Kvarnes L. Naprox en sodium versus pentazocine in treat-ing postoperative pain. Current Therapeutic Research1989; 46: 259-68.

12 Watters C, Pat terson C, Ma thews H, Cam pbel l W. Diclo*fenac sodium fo r post-tonsillectomy pain in children.Anaesthesia 1988; 43: 641 -3.

R e f e r e n c e s1 Chi l -Cheng, Cole LP. Incidence of pain among w omen

undergoing laparoscopic sterilization by electrocoagu-lation, the spring-loaded clip, and the tuba l ring. Am JObstet Gynecol 1979; 135: 397-401.

2 Br od i e B L Cas pe r RF . Prostaglandins mediatepostoperative pain in Falope ring sterilization. Am JObstet Gyne col 1985; 151: 175-7.

3 Ak e r l und M, S t r ombe r g P . Comparison o f ketoprofen andnaproxen in the treatment of dysmenorrhoea, with specialregard to time o f onset of pain relief . Curt Med Res Opin1989; 11: 485-90.

4 Hus k i s s on E C Measurement of pain. Lancet 1974; 1:1127-31.5 Hua ng K, Wol fe W, Tsueda K, S impso n P, Caissie

K. Effects of meclofenamate and acetaminophen on ab-dominal pain following tubal occlusion. Am J O bstetGynecol 1986; 155: 624 -9.

6 Burne y RG, Soni V. Intraperitoneal local anaesthetics fortubal ligation. Regional Anesthesia 1982; 7: 74.

7 Filmer HS. A double-blind randomized comparison ofnaproxen sodium, acetaminophen and pentazocine inpostoperative pain. Current Therapeutic Research 1980;27: 293-301.