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Objective   The aim of this study was to compare the effectiveness of spinal anesthesia with subdiaphragmatic lidocaine at the beginning of surgery versus spinal anesthesia in pain reduction for gynecological laparoscopic surgery.Methods   This was a clinical trial conducted in Arash Hospital, Tehran, Iran. Eighty-four patients were randomized to either spinal anesthesia with subdiaphragmatic lidocaine, spinal anesthesia, or general anesthesia (GA). The primary outcome was patients' pain perception during surgery, 2, 4, 6, and 12 hours after surgery, and prior to discharge and was assessed by visual analogue scale (VAS).Results   The results showed that there are no significant changes in pain perception over time in none of the three groups ( F (4,76) = 0.37,  P  = 0.82). The severity of pain experienced by patients at all-time interval after surgery was similar between groups [ F (2,79) = 0.54,  P  = 0.58].Conclusion   The use of subdiaphragmatic lidocaine at the beginning of surgery combined with spinal anesthesia was not associated with a statistically significant difference in patients' postoperative VAS scores compared to spinal anesthesia and GA during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial by the number of  IRCT2016022226698N1 .

pain research and management

Spinal Anesthesia and Spinal Anesthesia with Subdiaphragmatic Lidocaine in Shoulder Pain Reduction for Gynecological Laparoscopic Surgery: A Randomized Clinical Trial