Department of Gynecology, Obstetrics and Reproductive Medicine, Pôle femmes parents enfants, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France.
Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397, Marseille, France.
J Assist Reprod Genet. 2017 Nov;34(11):1523-1528. doi: 10.1007/s10815-017-1002-7. Epub 2017 Jul 28.
Does the type of anesthesia (paracervical block (PCB) or general anesthesia (GA)) impact live birth rate, pain, and patient satisfaction?
A non-randomized prospective cohort study was conducted in women treated for IVF. Two groups of patients were prospectively included: the PCB group (n = 234) and the GA group (n = 247). The type of anesthesia was determined by the patients. The primary endpoint was cumulative live birth rate by OR. Secondary endpoints were self-assessment of the patients' peri-operative abdominal and vaginal pain vs the doctors' evaluations during PCB, post-operative abdominal and vaginal pain level, and patient satisfaction in both groups. Pain levels were assessed with a numerical rating scale (NRS).
The live birth rate was similar in both groups (19.8% in the GA group vs 20.9% in the PCB group, P = 0.764). During oocyte retrieval in the PCB group, the physicians significantly under-estimated the vaginal pain experienced by the patients (3.04 ± 0.173 for patients vs 2.59 ± 0.113 for surgeons, P = 0.014). Post-operative vaginal and abdominal pain were significantly greater in the PCB group compared to the GA group (2.26 ± 0.159 vs 1.66 ± 0.123, respectively, P = 0.005, and 3.80 ± 0.165 vs 3.00 ± 0.148, respectively, P < 0.001). Patients were more significantly satisfied with GA than with PBC (P < 0.001).
Because the LBR was similar in both groups and patient satisfaction was high, the choice of anesthesia should be decided by the patients.
麻醉类型（宫颈旁阻滞（PCB）或全身麻醉（GA））是否会影响活产率、疼痛和患者满意度？
对接受 IVF 治疗的女性进行了非随机前瞻性队列研究。前瞻性纳入了两组患者：PCB 组（n=234）和 GA 组（n=247）。麻醉类型由患者决定。主要终点是 OR 计算的累积活产率。次要终点是患者自我评估的围手术期腹部和阴道疼痛与医生在 PCB 期间的评估、术后腹部和阴道疼痛程度以及两组患者的满意度。疼痛程度采用数字评分量表（NRS）评估。
两组的活产率相似（GA 组为 19.8%，PCB 组为 20.9%，P=0.764）。在 PCB 组取卵期间，医生明显低估了患者的阴道疼痛（患者为 3.04±0.173，外科医生为 2.59±0.113，P=0.014）。与 GA 组相比，PCB 组术后阴道和腹部疼痛明显更大（分别为 2.26±0.159 对 1.66±0.123，P=0.005，和 3.80±0.165 对 3.00±0.148，P<0.001）。与 PCB 相比，患者对 GA 的满意度更高（P<0.001）。
由于两组的 LBR 相似且患者满意度高，麻醉选择应由患者决定。
