A double‐blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain

N P Johnson, Neil Johnson, C M Farquhar, Cindy Farquhar, S Crossley, Y Yu, Yibo Yu, A M Van Peperstraten, Arno M van Peperstraten, M Sprecher, J Suckling, Jane A Suckling
BJOG: An International Journal of Obstetrics & Gynaecology · 2004 · vol. 111(9) , pp. 950–959 · doi:10.1111/j.1471-0528.2004.00233.x · PMID:15327610 · W2086751058
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Laparoscopic uterine nerve ablation improved dysmenorrhea in women without endometriosis but not other pain types, and did not benefit women with endometriosis.

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Abstract

OBJECTIVE: To determine the effectiveness of laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain in women with endometriosis and women with no laparoscopic evidence of endometriosis. DESIGN: A prospective double-blind randomised controlled trial (RCT). SETTING: Single-centre, secondary-level gynaecology outpatient service and tertiary-level pelvic pain and endometriosis outpatient service in Auckland, New Zealand. POPULATION: One hundred and twenty-three women undergoing laparoscopy for investigation and management of chronic pelvic pain, 56 with no laparoscopic evidence of endometriosis and 67 with endometriosis. METHODS: Women were randomised from the two populations, firstly those with no evidence of endometriosis and secondly those undergoing laparoscopic surgical treatment for endometriosis, to receive LUNA or no LUNA. Participant and assessor blinding was employed. Follow up for pain outcomes was undertaken at 24 hours, 3 months and 12 months. MAIN OUTCOME MEASURES: Changes in non-menstrual pelvic pain, dysmenorrhoea, deep dyspareunia and dyschezia were assessed primarily by whether there was a decrease in visual analogue score for these types of pain of 50% or more from baseline and additionally whether there was a significantly different change in median visual analogue score. The numbers requiring further surgery or starting a new medical treatment for pelvic pain and complications were also measured. RESULTS: There was a significant reduction in dysmenorrhoea at 12 month follow up in women with chronic pelvic pain in the absence of endometriosis who underwent LUNA (median change in visual analogue scale (VAS) from baseline -4.8 versus-0.8 (P= 0.039), 42.1%versus 14.3% experiencing a successful treatment defined as a 50% or greater reduction in visual analogue pain scale for dysmenorrhoea (P= 0.045). There was no significant difference in non-menstrual pelvic pain, deep dyspareunia or dyschezia in women with no endometriosis undergoing LUNA versus no LUNA. The addition of LUNA to laparoscopic surgical treatment of endometriosis was not associated with a significant difference in any pain outcomes. CONCLUSIONS: LUNA is effective for dysmenorrhoea in the absence of endometriosis, although there is no evidence of effectiveness of LUNA for non-dysmenorrhoeic chronic pelvic pain or for any type of chronic pelvic pain related to endometriosis.

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Outcome instruments

VAS-pain

Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Catheter Ablation Endometriosis Laparoscopy Nerve Block Pelvic Pain Uterus Adolescent Adult Catheter Ablation Chronic Disease Double-Blind Method Endometriosis Endometriosis Female Humans Laparoscopy Middle Aged Nerve Block Pelvic Pain Reoperation

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