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Article No. 5
A randomised trial comparing
local versus general anaesthesia for microwave endometrial ablation
Objective
To compare the acceptability of microwave endometrial ablation using a local anaesthesia/sedation
regime or general anaesthesia. To compare recovery following treatment with each
type of anaesthetic.
Design
Prospective randomised controlled trial with follow up of women who declined randomisation.
Setting
The gynaecology department of a large teaching hospital in the UK.
Population
All women referred for microwave endometrial ablation at the Aberdeen Royal Infirmary
between July 1999 and September 2000 without a medical reason to favour one or
other type of anaesthetic.
Methods
191 women were equally randomised to undergo microwave endometrial ablation under
general or local anaesthesia. Details were also collected for women not randomised
because of an anaesthetic preference. All procedures were undertaken in an operating
theatre.
Main outcome measures
Data collected by questionnaire including the woman's view of treatment acceptability,
operative details and post-operative recovery.
Results
Sixty-nine percent of eligible women would consider treatment under local anaesthesia.
Ninety-one percent of microwave endometrial ablation procedures that started under
local anaesthesia were completed without conversion to general anaesthesia. Anaesthetic
type and allocation by randomisation or preference made no significant difference
to the proportion of women describing treatment as totally or generally acceptable
at two weeks. Neither parity nor cavity size predicted acceptability. Women allocated
general anaesthesia were more likely to describe the procedure as totally acceptable
and to choose the same anaesthetic again. There was no significant difference
between anaesthetic groups regarding post-operative pain, nausea or recovery time.
Conclusions
Microwave endometrial ablation under local anaesthesia was acceptable to the majority
of women referred for treatment. There was no recovery advantage from local anaesthesia
and almost 1 in 10 women who starting treatment under local anaesthesia needed
a general anaesthetic because of discomfort. The incidence of post-operative pain
and nausea means that treatment with this local anaesthetic/sedation regime remains
a day case rather than an outpatient procedure.
Source : BJOG: An International Journal of Obstetrics and Gynaecology
Volume 110, Issue 9 , September 2003, Pages 799-807
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