Anesthesia and Analgesia for Office-Based Uterine Procedures

Chapter

Abstract

While available evidence shows that diagnostic hysteroscopy can be performed in many patients with little or no analgesia or anesthesia, for some women, there is significant discomfort with the procedure, and many can benefit from the use of local anesthetic techniques. Operative hysteroscopic procedures can also be performed in the office setting, but there are challenges to performing such interventions using local anesthesia. There is little available evidence describing effective anesthetic techniques for operative hysteroscopy, a circumstance that invites both a creative approach and critical evaluation with appropriately rigorous investigation. The uterus possesses at least two distinctly different sources of innervation; the cervix is supplied by S2–4 largely through the uterosacral ligaments while the corpus receives sensory afferents via the T10–L1 roots that access the uterine architecture at the isthmus and via the ovarian ligaments. Theoretically, at least, the strategy for the effective use of local uterine anesthesia must consider these multiple sources of innervation as well as other factors including the procedure to be performed, the instrumentation to be used, selection of appropriate anesthetic agents, and the allowance of adequate elapsed time for a maximal anesthetic effect. An approach utilizing several simultaneously applied techniques is described together with patient pain outcomes suggesting that a wide spectrum of procedures can be performed in an office setting, under local anesthesia.

Keywords

Uterine local anesthesia Cervical block Paracervical block Office procedures 

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Kaiser Permanente, Los Angeles Medical CenterLos AngelesUSA

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