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Prša G, Serdinšek T, But I. Exploring the rationale of performing vaginal hysterectomy under local anaesthesia: A single-centre experience. Eur J Obstet Gynecol Reprod Biol 2024; 299:131-135. [PMID: 38865739 DOI: 10.1016/j.ejogrb.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/22/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Vaginal hysterectomy (VH) is usually performed under general (GA) or regional anaesthesia. In recent years, the possibility of performing vaginal hysterectomy under local anaesthesia (LA) has also been explored. Our aim was to compare intraoperative and early postoperative outcomes in women who underwent VH under LA with intravenous sedation or GA. METHODS In this retrospective study, we collected data of patients who underwent VH at our department from June 2021 to December 2022. For every patient, the following data was obtained: hospitalisation duration, type of anaesthesia (LA or GA), accompanying procedures, the dosage of used local anaesthetic in the LA group, maximal pain score for each day of hospitalisation after the procedure, procedure duration, intraoperative blood loss, and postoperative complication rate. Data was analysed using the SPSS Statistics programme. Statistical significance was set at p < 0.05. RESULTS Seventy patients were included in the study. The mean age was significantly higher in the LA group compared to GA group (73.8 ± 8.0 years vs. 67.1 ± 9.3 respectively, p-value = 0.003). LA was associated with statistically lower pain scores in the first two days after the procedure (p = 0.003), and shorter procedure duration (p-value <0.001) as well as hospitalisation duration (p < 0.001). Furthermore, the cumulative dosage of different analgesics used during hospitalisation was higher in the GA group. CONCLUSIONS Our results show that LA is a feasible option for patients undergoing VH. Vaginal surgical procedures under LA could be especially beneficial for older patients with medical comorbidities in whom GA would be particularly hazardous.
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Affiliation(s)
- Gregor Prša
- Department of Gynaecology and Obstetrics, General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, 9000 Murska Sobota, Slovenia
| | - Tamara Serdinšek
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - Igor But
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
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Gluck O, Amram S, Feldstein O, Barber E, Tamayev L, Weiner E, Oren B, Ginath S. The Effect of Preemptive Local Infiltration on Postoperative Pain After Vaginal Hysterectomy: a Retrospective Study. J Minim Invasive Gynecol 2022; 30:308-311. [PMID: 36543269 DOI: 10.1016/j.jmig.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/18/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE To investigate the effect of preemptive infiltration on postoperative pain and the use of analgesics after vaginal hysterectomy (VH). DESIGN A retrospective study. SETTING An urogynecology unit in a tertiary medical center. PATIENTS A total of 120 patients who had undergone VH. INTERVENTIONS The study group contained 60 patients who participated in a former randomized control study, in which preemptive local infiltration of bupivacaine (n = 30) or sodium chloride 0.9% (n = 30) was performed. The control group included 60 consecutive patients who underwent a VH, for whom no local infiltration was performed. MEASUREMENTS AND MAIN RESULTS Postoperative pain at rest was assessed using the 10 cm visual analog scale at 3, 8, and 24 hours after surgery. The levels of pain, as well as the use of analgesics, postoperatively, were compared between the groups. The mean surgery length in the infiltration group was shorter (86.4±29 vs 118.6±30, p <.001) and the rate of posterior colporrhaphy was lower (73.1% vs 91.3%, p = .010) than the control group. There were no differences in levels of pain at all points of time. However, the infiltration group required a lower morphine dose in the recovery unit (3.7 ± 2.3 mg vs 5.3 ± 2.4 mg, p <.001) and less use of analgesia (all kinds) 24 hours after surgery (54.2% vs 79.6%, p <.001) compared with the control group. On multivariant analysis, preemptive infiltration was found to be independently inversely associated with the dose of morphine used in recovery, as well as analgesics used 24 hours after surgery. CONCLUSION Preemptive local infiltration of either bupivacaine or sodium chloride 0.9% reduced the use of morphine in the recovery unit, as well as the use of analgesics 24 hours after VH, compared with no infiltration at all.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel.
| | - Stav Amram
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; The Adelson School of Medicine, Ariel University (Amram), Ariel, Israel
| | - Ohad Feldstein
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
| | - Liliya Tamayev
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
| | - Ben Oren
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University (Oren), Safed, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath; and Amram, Oren), Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University (Drs. Gluck, Feldstein, Barber, Tamayev, Weiner and Ginath), Tel Aviv, Israel
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Housmans S, Stuart A, Bosteels J, Deprest J, Baekelandt J. Standardized 10-step approach for successfully performing a hysterectomy via vaginal natural orifice transluminal endoscopic surgery. Acta Obstet Gynecol Scand 2022; 101:649-656. [PMID: 35451501 DOI: 10.1111/aogs.14367] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Vaginal natural orifice transluminal endoscopic surgery (NOTES) is a novel technique for minimally invasive gynecological surgery. Adequate training and standardization are key elements to patient safety and quality of care. Based on consensus statements and expert opinion; we report a step-by-step guidance for hysterectomy via natural orifice transluminal endoscopy. A detailed description is presented of pre- and postoperative care, and the instruments and equipment used, and surgical steps are illustrated by photographic images. This report can guide surgeons in their training to perform a hysterectomy via NOTES.
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Affiliation(s)
- Susanne Housmans
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Stuart
- Department of Obstetrics and Gynecology, Helsingborg Hospital, Helsingborg, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jan Bosteels
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Imelda Hospital, Bonheiden, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Baekelandt
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Imelda Hospital, Bonheiden, Belgium
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