Outpatient laparoscopy with local anesthesia

Is local anesthesia an affordable alternative to general anesthesia for minilaparoscopy?

STUDY OBJECTIVE

To determine if minilaparoscopy under local anesthesia is at least as reliable and affordable as that performed under general anesthesia.

DESIGN

Prospective, randomized study (Canadian Task Force classification I).

SETTING

University-affiliated hospital.

PATIENTS

One hundred sixty-four consecutive women evaluated for infertility.

INTERVENTION

Diagnostic minilaparoscopy performed after women were randomized to receive general or local anesthesia with conscious sedation.

MEASUREMENTS AND MAIN RESULTS

Levels of postoperative pain measured by visual analog scale; volume of CO(2) used; length of procedure, complete pelvic evaluation, and hospitalization; complications; and pathologic diagnosis were evaluated. The groups were comparable in age, years of infertility, and symptoms. For women receiving local anesthesia, 5.5% required general anesthesia to complete the procedure. Women in both groups required postoperative analgesics. The groups had no statistically significant differences in pain level 1 hour after the procedure, number of complications, and pelvic pathology. Patients who had local anesthesia required a smaller volume of CO(2) (p <0.01) and their hospitalization was significantly shorter (p <0.01). However, in 15% of these women pelvic visualization was incomplete, compared with 7.2% in the general anesthesia group.

CONCLUSION

Minilaparoscopy performed under local anesthesia was as reliable and affordable as when performed under general anesthesia.

Laparoscopic sterilisation with the Filshie clip under local anaesthesia

A technique for performing laparoscopic sterilisation under local anaesthesia and without systemic sedation is described. A mechanical tubalocclusion clip was employed. The procedure, and the technique of local anaesthesia are compared with other methods of sterilisation.