The efficacy and safety of the tension-free vaginal tape procedure do not depend on the method of analgesia.
OBJECTIVE
The original tension-free vaginal tape (TVT) method, described by Ulmsten et al., routinely uses local anaesthesia during the procedure. Since the anaesthetic effect after local application of lidocaine hydrochloride was not always satisfactory we decided to introduce the spinal anaesthesia during this operation. The aim of the present study was to compare local and spinal anaesthesia with respect to their efficacy and safety in the TVT procedure.


METHODS
103 women, with objectively confirmed stress urinary incontinence, were randomised into the study. Sixty-seven women were anaesthetised locally and 36 patients spinally. All TVT procedures were performed as originally described. Objective assessment of the influence of anaesthesia on intra-abdominal pressure at rest and during the cough test was done using a rectal catheter and a central venous pressure manometer. The efficacy of the TVT procedure was based on a gynaecological examination with a cough test and a three-degree subjective scale: complete cure, improvement or failure.


RESULTS
The success of the TVT procedure performed under local anaesthesia is comparable with that achieved under spinal analgesia (p=0.42). The number of complications that occurred in the two groups does not differ significantly (p=0.57).


CONCLUSIONS
Spinal anaesthesia impairs the ability to cough effectively during the TVT procedure. However, the efficacy and safety of the operations performed under this type of anaesthesia are comparable with the efficacy and safety of operations done under local anaesthesia.
Department of Gynaecological Surgery, University School of Medicine, 20-954 Lublin, Jaczewskiego 8, Poland. adamiak@yahoo.com
Aneta
A
Adamiak
Paweł
P
Milart
Paweł
P
Skorupski
Katarzyna
K
Kuchnicka
Andrzej
A
Nestorowicz
Jerzy
J
Jakowicki
Tomasz
T
Rechberger
D000328:Adult; D000772:Anesthesia, Local; D000775:Anesthesia, Spinal; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D018709:Statistics, Nonparametric; D013523:Surgical Equipment; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina