Department of Anesthesiology and Pain Management, Alexandra General Hospital, Athens, Greece;
Urogynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
In Vivo. 2024 Sep-Oct;38(5):2425-2433. doi: 10.21873/invivo.13711.
BACKGROUND/AIM: Hysterectomy is the most frequent gynecological surgery. Vaginal hysterectomy (VH) seems to be related to favorable perioperative outcomes compared to abdominal or laparoscopic approaches. As the population ages, anesthesia that is safer for the elderly, such as local anesthesia (LA) with conscious sedation, is gaining popularity and is related to favorable outcomes in patients' recovery compared to general or regional anesthesia. We aimed to evaluate the efficacy of dexmedetomidine versus propofol for women undergoing VH for uterine prolapse under LA and conscious sedation.
A prospective study on 40 women with uterine prolapse stage ≥3 who had VH under LA with conscious sedation under either dexmedetomidine (n=20) or propofol (n=20) was performed. A standardized surgical approach with continuous hemodynamic monitoring and sedation assessment using the Ramsay Sedation Scale (RSS) was conducted. The primary endpoint of the study was to determine the percentage of patients receiving intraoperative fentanyl.
Analysis of outcomes demonstrated a significant reduction in the proportion of patients requiring intraoperative rescue fentanyl (35% vs. 5%, respectively, p=0.04) and in postoperative pain scores, with more patients achieving an optimal RSS score of 3 in the dexmedetomidine group.
Based on the findings of the present study, dexmedetomidine offered superior analgesia and patient comfort compared to propofol, suggesting a favorable anesthetic profile for VH under LA.
背景/目的：子宫切除术是最常见的妇科手术。阴道子宫切除术（VH）似乎与更好的围手术期结果相关，与腹部或腹腔镜方法相比。随着人口老龄化，对老年人更安全的麻醉，如局部麻醉（LA）加镇静，越来越受欢迎，与全身或区域麻醉相比，患者恢复的结果更好。我们旨在评估右美托咪定与丙泊酚在 LA 加镇静下用于阴道子宫切除术治疗子宫脱垂的疗效。
对 40 名子宫脱垂≥3 期的患者进行了一项前瞻性研究，这些患者在 LA 加镇静下接受 VH，分别接受右美托咪定（n=20）或丙泊酚（n=20）。采用标准化手术方法，持续进行血流动力学监测，并使用 Ramsay 镇静评分（RSS）评估镇静。研究的主要终点是确定术中需要芬太尼的患者比例。
对结果进行分析表明，需要术中抢救性芬太尼的患者比例显著降低（分别为 35%和 5%，p=0.04），术后疼痛评分也显著降低，右美托咪定组更多的患者达到了 RSS 评分 3 的最佳状态。
根据本研究的结果，与丙泊酚相比，右美托咪定提供了更好的镇痛和患者舒适度，表明在 LA 下进行 VH 具有更好的麻醉特征。
