Low Cost, Patient Acceptable, Local Analgesia Approach to Gynaecological Outpatient Surgery A Review of 817 Consecutive Procedures

EDITORIAL COMMENT: We have accepted this and the following paper by the same authors since they describe the results of a large series of gynaecological day case procedures, especially endometrial resection, performed under local analgesia achieved by intracervical block. From the figures provided in the following paper it would appear that, in the authors' practice, 45.7% (278 of 608) of women who satisfy the clinical requirements for endometrial resection are suitable for and agreeable to the procedure being performed under local analgesia. The comparable rate of complications following endometrial resection performed with local versus general anaesthesia, and the 90% rate of patient satisfaction at follow‐up in the local analgesia group, indicates that outpatient gynaecological surgery, asoutlinedin these papers, warrants consideration in all hospitals in which these procedures are performed extensively. Factors that determine patient acceptance of local analgesia should be analyzed. It is not everybody who wishes to see the details of their outpatient procedure on video screen! The amnesia induced by intravenous analgesia is appreciated by many such patients. As funding of hospitals becomes increasingly dependent upon items of service delivered, the minutiae of the day case surgery become more important. The editorial committee wish to stress the need for authors of such studies to carefully provide information regarding patients reaction to the procedure itself, the incidence of complications and both short‐term and long‐term results. Summary: The objective of this study was to evaluate safety, cost effectiveness and patient acceptability, of performing a wide variety of gynaecological procedures, including endometrial resections, in a clinic using only local analgesia. Eight hundred and seventeen consecutive gynaecological procedures were performed under local analgesia only, with no sedation, including endometrial resections, cone biopsies, terminations of pregnancy, hysteroscopies, and local vaginal and plastic vulval procedures, as well as many combined procedures (figure 1) in a day‐surgery ward annexe in the Department of Gynaecology, St John's District General Hospital, Chelmsford Essex. The main outcome measures were patient acceptability, safety and encountered side‐effects of procedures performed under local analgesia as well as evaluation of cost‐effectiveness and reduction in theatre waiting list times. A high degree of safety and patient acceptability was achieved, with other considerable benefits being short waiting times and much quicker recovery. The only complications were from the endometrial resection group, with only 8 (3.6%) of these requiring intravenous sedation intraoperatively, and 6 (2.7%) requiring overnight admission. No transfers to theatre during any procedure occurred. Savings per procedure, in cost and in patient's time, were very considerable. Conclusion: The local analgesia approach for a wide variety of gynaecological procedures in a combined outpatient theatre is safe and is highly acceptable to patients. There are also considerable benefits in cost and patient convenience, with a reduction in operating list waiting time, which in the current economic climate are worth considering.