Sahay Nishant, Agarwal Mukta, Bara Mamta, Raj Nutan, Bhushan Divendu
Department of Anesthesiology, AIIMS, Patna, Bihar, India.
Department of Obstetrics, AIIMS, Patna, Bihar, India.
Gynecol Minim Invasive Ther. 2019 Oct 24;8(4):160-164. doi: 10.4103/GMIT.GMIT_12_19. eCollection 2019 Oct-Dec.
Many minor gynecological procedures are done for diagnostic and therapeutic reasons. A balance has to be struck between ability to discharge a patient at the earliest with minimum procedure-related discomfort to ensure patient safety as well as satisfaction.
This prospective randomized study was designed to compare deep sedation versus paracervical block for minor gynecological surgeries comparing the time to discharge readiness, pain after the procedure, and overall patient satisfaction.
This prospective randomized comparative study was conducted at a tertiary level hospital after institutional ethics committee approval and registry of trial at CTRI (India).
Seventy young women underwent minor gynecological procedures under these two modes of anesthesia. Time to discharge readiness from hospital to home was assessed using modified postanesthesia discharge score system (PADSS). Pain after procedure as well as patient satisfaction was evaluated. Patients were also asked whether they would recommend the same anesthetic technique for the procedure in the future. Answers were noted on a Likert scale.
Patients were ready to be discharged faster in deep sedation group compared to paracervical block group based upon modified PADSS score (1 h 9.6 min vs. 1 h 18 min) ( = 0.005). Pain in the perioperative period was analyzed using repeated-measures ANOVA and found to be significantly lesser in deep sedation group when considered till 80 min after surgery. The mean satisfaction score in patients who underwent deep sedation was 91.24 (standard deviation [SD] 2.8) compared to patients given paracervical block which was low at 64.67 (SD 15.8). All patients given deep sedation were ready to recommend the anesthesia technique as compared to only 53.3% of patients who were given paracervical block.
Deep sedation may be preferred over paracervical block for daycare minor gynecological procedures.
许多小型妇科手术是出于诊断和治疗目的而进行的。必须在尽早让患者出院的能力与将手术相关不适降至最低之间取得平衡，以确保患者安全和满意度。
本前瞻性随机研究旨在比较深度镇静与宫颈旁阻滞用于小型妇科手术时的出院准备时间、术后疼痛及患者总体满意度。
本前瞻性随机对照研究在一家三级医院进行，经机构伦理委员会批准并在CTRI（印度）注册。
70名年轻女性在这两种麻醉方式下接受小型妇科手术。采用改良的麻醉后出院评分系统（PADSS）评估从医院准备出院回家的时间。评估术后疼痛及患者满意度。还询问患者未来是否会推荐相同的麻醉技术用于该手术。答案采用李克特量表记录。
根据改良的PADSS评分，深度镇静组患者比宫颈旁阻滞组更快准备好出院（1小时9.6分钟对1小时18分钟）（P = 0.005）。采用重复测量方差分析对围手术期疼痛进行分析，发现在术后80分钟内，深度镇静组的疼痛明显较轻。接受深度镇静的患者平均满意度评分为91.24（标准差[SD] 2.8），而接受宫颈旁阻滞的患者满意度较低，为64.67（SD 15.8）。与仅53.3%接受宫颈旁阻滞的患者相比，所有接受深度镇静的患者都愿意推荐该麻醉技术。
对于日间小型妇科手术，深度镇静可能比宫颈旁阻滞更可取。
