Comparison of anesthetic methods for microlaparoscopy in women with unexplained infertility

Study Objective. To evaluate the effectiveness of ketamine compared with fentanyl as analgesia or sedation for microlaparoscopy. Design. Prospective, randomized study (Canadian Task Force classification I). Setting. University-affiliated hospital. Patients. Forty-one infertile women. Interventions. Twenty-one patients were randomly assigned to have analgesia with fentanyl and 20 sedation with ketamine during microlaparoscopy. Maximum doses were 0.2 and 200 mg, respectively. Local anesthesia was provided with 0.25% bupivacaine 5 ml injected into cannula sites. Measurements and Main Results. Abnormal findings such as endometriosis and periadnexal adhesions were identified in 24 patients. Ablation, coagulation, and adhesiolysis were easily performed in 14 (82.4%) of 17 women receiving ketamine, but difficulties were encountered in operating on 16 patients receiving fentanyl. Ketamine was administered to 10 patients (47.6%) in the fentanyl group because anxiety and pain were not sufficiently controlled by fentanyl. There were no significant differences in visual analog scale scores and recovery time between groups. On questionnaire, 19 (95%) of 20 patients receiving ketamine indicated they would choose the same anesthesia again if offered, compared with only 4 (19%) of 21 receiving fentanyl (p<0.001). Conclusion. Microlaparoscopy in infertile women was performed more effectively under sedation with ketamine than with fentanyl.