Stephen Searle
Speeches:
-
Why is local anaesthesia done so rarely?
Stephen Searle, MD, Clinical Director/Consultant in Contraception & Sexual Health, UK
The talk will cover:
The Technique
MVA, Evidence Worldwide
Practical Advantages & disadvantages of LA TOP>
Complications
Practical Advantages of MVA:
Effective up to 12/40 & down to 5/40; Moves TOPs out of theatre; Less frightening for
women; One visit, short stay; Inexpensive, low-tech; Enables non-gynaecologists to
evacuate Ut; Simple, safe & effective for ERPC; No need to undress; No need to be
starved; Can drive home; Less risk of uterine damage - GENTLE; Often suitable when GA
STOP or MTOP are relatively contraindicated eg gross obesity, oral steroid treatment
Disadvantages:
Pain: Audit indicates there is less pain with LA than with MTOP and possibly less than
after women awake from GA STOP
Pain more likely with Primips, teenagers, if frightened or depressed, higher gestations.
However: 70-90% would choose LA again
Evidence on Analgesia
Observational studies:
less pain with Cx block than none
20ml better than smaller vol
inj @ 4 and 8 o'clock
N2 O. x2 RCTs:Entonox: BPAS 1st 501
22% used N2 O - of these:
28% - very helpful
58% - Moderately helpful/some help
11% - no help
CONCLUSION: After 1st 250, staff were reminded to routinely offer N2 O.
Recommendation
"..hospitals should abandon curettage.. and adopt the aspiration methods, selecting
manual evacuation and/or electric aspiration, according to the expertise available."
Ref: Final Report, FIGO/WHO Task Force, March 1997
Contraindications to MVA:
Gestation > 12/40
Anticoagulant Rx/Prolonged bleeding time
Haematocrit < 30%
Active PID
HEALTH ECONOMICS
GA STOP £430
MTOP £260
LA VTOP £190 (4 on list)
Appendix. USA Complications
Local vs. General Anaesthetic. Grimes 1979, Am J Ob Gyn.
36,430 LA vs 17,725 GA
Blood Transfusion, Cervical Tears, Perforations: x3 - x4 greater with GA
Anaesthetic deaths: a GA complication
BPAS + MSI: 1998-2000. N = 2,026
ERPC = 6 (0.29%)Blood transfusion = 0
Hospital admission = 2 (0.09%)
1 confirmed ectopic
1 pain, anxiety, continuing pregnancy