title: Parenterally administered moderate sedation and paracervical block versus general anesthesia for hysteroscopic polypectomy: a pilot study comparing postoperative outcomes.
abstract: OBJECTIVE
  To compare parenterally administered moderate sedation and paracervical block versus general anesthesia during day-case operative hysteroscopy for polypectomy in terms of patients' postoperative pain perception, operating time, and postoperative drug administration.
  
  
  METHODS
  A pilot study (Canadian Task Force classification I).
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Women undergoing hysteroscopic polypectomy procedures (N = 56).
  
  
  METHODS
  Hysteroscopic polypectomy with general anesthesia or moderate parenteral sedation and paracervical block.
  
  
  RESULTS
  The patients were divided into 2 groups: 26 underwent general anesthesia (group 1), and 30 were submitted to moderate parenteral sedation and a paracervical block (group 2). General anesthesia was induced with the laryngeal mask airway with propofol (1% 1-2.5 mg/kg) and fentanyl (1-2 μg/kg) and maintained with an infusion of propofol (2% 3-5 mg/kg/h). After the procedure, patients in the general anesthesia group received postoperative analgesic medication with paracetamol (20 mg/kg) and ketorolac (0.6 mg/kg) or tramadol (2-3 mg/kg). The group receiving moderate parenterally sedation and a paracervical block received a paracervical block with mepivacaine (1% 10 mL) and lidocaine (2% 10 mL) and received fentanyl (1 μg/kg) and propofol (1% 1-3 mg/kg/h) maintaining spontaneous breathing. A blind observer recorded the operative time and the discomfort of patients using a 4-step scale (0-3). The postoperative pain assessment was performed 3 hours after the procedure with a self-administered validated tool, the Brief Pain Inventory. We found that women receiving moderate parenteral sedation and a paracervical block perceived significantly less pain in daily activity (p < .001), walking (p < .001), daily work (p < .001), relations with others (p = .007), sleep (p < .001), and pain contrasting enjoyment of life (p < .001). The total amount of time spent in the operating room in group 2 was significantly lower than in group 1 (p < .014).
  
  
  CONCLUSIONS
  Moderate sedation plus a paracervical block for operative hysteroscopy is associated with reduced pain perception and a shorter operative time.
authors.affiliation: Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Centini
authors.affiliation: Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Calonaci
authors.affiliation: Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy. Electronic address: lucialazzeri@email.it.
authors.forename: Lucia
authors.initials: L
authors.lastname: Lazzeri
authors.affiliation: Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Tosti
authors.affiliation: Department of Anesthesiology and Intensive Care, Azieda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Palomba
authors.affiliation: Department of Anesthesiology and Intensive Care, Azieda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Puzzutiello
authors.affiliation: Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Luisi
authors.affiliation: Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Petraglia
authors.affiliation: Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Errico
authors.initials: E
authors.lastname: Zupi
mesh_terms: D000328:Adult; D000700:Analgesics / Q000145:classification / Q000627:therapeutic use; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods; D000777:Anesthetics / Q000145:classification / Q000627:therapeutic use; D002170:Canada; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D010865:Pilot Projects; D011127:Polyps / Q000601:surgery*; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery*
chemical_list: D000700:Analgesics; D000777:Anesthetics
keywords: General anesthesia; Operative hysteroscopy; Operative time; Pain; Paracervical block