A double-blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain N.P. Johnson, C.M. Farquhar, S. Crossley, Y. Yu, A.M. Van Peperstraten, M. Sprecher, J. Suckling 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 ¼ 0.039), 42.1% versus 14.3% experiencing a successful treat- ment defined as a 50% or greater reduction in visual analogue pain scale for dysmenorrhoea (P ¼ 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. INTRODUCTION Chronic pelvic pain is a common condition that often has a profound impact on a woman’s personal health and quality of life, but also an economic impact through loss of working hours. 1 Such pain may present as dysmenor- rhoea (primary or secondary), non-menstrual pain, deep dyspareunia (pain with sexual intercourse) or dyschezia (defaecatory pain). Treatment of the condition is sometimes unrewarding owing to a lack of effective interventions and more radical surgery, such as hysterectomy, often becomes the final option. 1 If conservative surgery can be shown to be effective, this would represent a major improvement in the management of chronic pelvic pain. Endometriosis is the most common identifiable pathological condition asso- ciated with chronic pelvic pain. Although laparoscopic surgical treatment of endometriosis has been shown to be effective for pain relief, 2 not all women experience a sustained benefit from surgery. Medical treatment for endometriosis-related pain carries a high incidence of side effects and the benefit is not sustained once treatment ceases. 3 If a simple procedure to ablate the important sensory afferent nerves carrying pain stimuli from the pelvis could be carried out, this could theoretically be beneficial for all women with chronic pelvic pain. Uterine nerve ablation involves the transection of the uterosacral ligaments close to their insertion into the cervix. The procedure interrupts pelvic afferent sensory nerve fibres of the Lee–Frankenhauser nerve plexus (Fig. 1). BJOG: an International Journal of Obstetrics and Gynaecology September 2004, Vol. 111, pp. 950–959 D RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology www.blackwellpublishing.com/bjog Department of Obstetrics and Gynaecology, National Women’s Hospital, University of Auckland, Auckland, New Zealand Correspondence: Dr N. P. Johnson, Department of Obstetrics and Gynaecology, National Women’s Hospital, University of Auckland, Auckland, New Zealand. DOI:10.1111/j.1471-0528.2004.00233.x