Zullo 2004.

Methods	Single centre study Allocation by envelopes containing computer‐generated random numbers Patients and care providers were blinded Power calculation: performed 4 (6.7%) patients (2 in each arm ) did not receive the assigned intervention because of concomitant disease (endometriosis) Withdrawals were excluded from the analysis
Participants	Setting: university hospital in Naples, Italy Inclusion criteria: symptomatic fibroids Exclusion criteria: liver disease, angina or ischaemic heart disease, chronic obstructive pulmonary disease, dyslipidaemia, diabetes, acute or recent vascular thrombosis, malignancy, intramural largest myoma less than 3 cm, or more than 5 cm, more than 2 myomas, calcification or hypoechoic leiomyoma, submucosal fibroids, cytologic evidence of endometrial atypia, abnormal Pap smear, or positive urine pregnancy test n = 60 Mean age: 28.2 years (SD 3.1) for treatment arm and 27.1 years (SD 2.9) for control arm Ethnicity: not described Number of myomas: mean 1.3 (SD 0.4) in treatment arm and 1.2 (SD 0.3) in control arm
Interventions	Treatment arm (n = 30): 50 ml of bupivacaine cloridrate 0.25% + 0.5 ml of epinephrine infiltrated into the serosa or myometrium overlying and just around the myoma before incision Control (n = 30): infiltration of normal saline Type of operation: laparoscopy
Outcomes	Perioperative blood loss, and operation time Blood loss was estimated from the balance between the aspirated and the irrigated liquid
Notes	Indications for myomectomy: history of infertility for more than 3 years, recurrent abortions during first trimester, increased vaginal bleeding, pelvic pressure and pain, urinary frequency, and constipation Author not contacted
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Allocation by envelopes containing computer‐generated random numbers
Allocation concealment (selection bias)	Low risk	Adequate
Incomplete outcome data (attrition bias) All outcomes	High risk	4 (6.7%) patients (2 in each arm ) did not receive the assigned intervention because of concomitant disease (endometriosis)
Selective reporting (reporting bias)	Unclear risk	We do not have access to the study protocol
Other bias	Low risk	No other sources of bias identified
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Patients and care providers were blinded
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessors were blinded