Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Article Gynecol Obstet Invest 2010;69:140–144 DOI: 10.1159/000267323 In-Office Thermachoice III Ablation: A Comparison of Two Anesthetic Techniques Hector O. Chapa Gonzalo Venegas Charles P. VanDuyne Luke Suvunrungsi Alfred G. Antonetti Jeffrey Sandate Women’s Specialty Center, Dallas, Tex., USA ‘very satisfied’ or ‘satisfied’ than IP patients. Conclusion: Patch intraoperative VAS pain scores are comparable to uter- ine block scores; postoperative VAS pain scores were statisti- cally lower with the FP. FP resulted in more favorable ‘satis- faction’ rates compared to IP. Copyright © 2009 S. Karger AG, Basel Introduction Several varied yet successful analgesic protocols have been described and published for the performance of in- office Thermachoice ablations. At one extreme, Marsh et al. [1, 2] reported an 89% successful procedure comple- tion rate with only a single preoperative oral dose of an NSAID. Additionally, the successful completion of simi- lar endometrial procedures has been reported using top- ically applied anesthetic to the cervix, cervical canal, and within the uterine cavity [3–5]. Despite these options, the most widely adopted protocols for these therapies involve some modification of paracervical/lower uterine local block, initially described for therapeutic/elective abor- tion [6–9] . We sought to investigate a less invasive anal- gesic option for the performance of in-office Therma- choice III endometrial ablations, via the use of fentanyl transdermal patches as the main analgesic agent. Key Words In-office ablations  Local anesthesia  Transdermal anesthesia Abstract Background: Patient comfort and safety are prerequisites for office procedures. Study objective: comparison of the fentanyl transdermal patch with injection of local anesthesia for intraoperative/postoperative pain from in-office Ther- machoice III ablations. Methods: Single-center prospective randomized (1: 1) cohort study. Primary endpoint: intraop- erative and postoperative VAS pain scores (0 as no pain, 10 as extreme pain). Secondary endpoints: patient satisfaction between cohorts and adverse events. Results: 41 patients were randomized [21 patch protocol (FP), 20 injection proto- col (IP)]. For patch users, the median VAS scores were 2.60 (range 1–4) intraoperatively and 3.30 (range 2–5) postopera- tively (p = 0.09, CI = –0.8 to 0.4), with the most common ad- verse events being nausea (62%) and vomiting (38%). Com- pared to injection, there was no significant difference in intraoperative VAS score (FP median VAS = 2.60, IP median VAS = 2.59; p = 0.15, CI = –0.05 to 0.48), but a significant differ- ence postoperatively (FP median VAS = 3.30, IP median VAS = 6.0; p = 0.01, CI = –2.6 to –1.4). Less NSAIDs were used postoperatively with the FP. At 24 h, more FP patients were Received: May 14, 2009 Accepted after revision: October 27, 2009 Published online: December 18, 2009 Hector O. Chapa, MD Women’s Specialty Center 1135 N Bishop Ave Dallas, TX 75208 (USA) Tel. +1 214 334 8116, Fax +1 214 942 8030, E-Mail ChapaMD @ aol.com © 2009 S. Karger AG, Basel 0378–7346/10/0692–0140$26.00/0 Accessible online at: www.karger.com/goi