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ObjectiveTo compare the efficiency of laparoscopically guided transversus abdominis plane block (LTAP) versus port‐site local anaesthetic infiltration (LAI) in reducing postoperative pain following laparoscopic excision of endometriosis.DesignA prospective, double‐blind randomised controlled trial.SettingA tertiary referral centre for endometriosis and minimally invasive gynaecological surgery.PopulationWomen undergoing laparoscopic excision of endometriosis from December 2015 through July 2016.MethodsParticipants were randomised to receive: port‐site infiltration with bupivacaine and placebo LTAP (LAI group, n = 21); placebo port‐site infiltration and LTAP with bupivacaine (LTAP group, n = 24); placebo port‐site infiltration and placebo LTAP (placebo group, n = 25).Main outcome measuresPost‐operative pain at 2–4, 6–8, 10–12 and 24 hours, analgesic requirements, TAP block‐related complications and opioid‐related adverse effects.ResultsThere were no differences in patient characteristics between the groups. In comparison with placebo, both LTAP and LAI groups had significantly less pain at 2–4, 6–8, and 10–12 hours (median 3, 3, 3.5 versus 3, 6, 4 versus 8, 8, 7 for LTAP, LAI, and placebo, respectively, P < 0.05). Median differences (and 95% confidence intervals) were as follows; LTAP versus placebo −5 (−6 to −4), −4 (−5 to −3), −3 (−4 to −0.5); LAI versus placebo −4 (−5 to −2), −2 (−3 to −0.5), −1 (−4 to −0.5) at 2–4, 6–8 and 10–12 hours, respectively. There were no statistically significant differences between the LTAP and LAI groups.ConclusionsLaparoscopically guided transversus abdominis plane block and LAI both reduce postoperative pain in patients undergoing laparoscopic excision of endometriosis, compared with placebo. We found no differences in effect between LTAP and LAI.Tweetable abstractTAP block and port‐site local infiltration are both effective in reducing postoperative pain in major gynaecological laparoscopic surgery.

Several classification systems have been proposed for endometriosis but the search for the ideal system is ongoing. While the most commonly used system has historically been r-ASRM, this system is not fit for purpose, particularly for deep endometriosis. In order to explore strategies to devise a new system and learn from problems with the existing ones, this study was designed to assess the reproducibility of each component in r-ASRM and its total score using videotaped laparoscopic procedures. Two surgeons independently scored 64 edited videos of laparoscopic endometriosis procedure, twice. Using the Kappa statistic, the agreement of the scores given was analyzed. r-ASRM showed a moderate inter-observer agreement (ƙ = 0.503) and good intra-observer agreement (ƙ = 0.774 and 0.682 for scorer 1 and 2 respectively) for overall disease staging. The agreement for each component of the system, however, was highly variable. The least agreement was observed for the peritoneum with ƙ = 0.157 and ƙ = 0.362 respectively for inter-observer and intra-observer. The lowest intra-observer agreement was seen for cul-de-sac for scorer 2 (ƙ = 0.382). Whilst the overall rASRM shows acceptable agreement between two scorers, this agreement seems to be the product of inconsistent scoring for each component.