FOUR YEARS EXPERIENCE WITH USAGE OFLOCAL ANESTHESIA FOR VAGINAL RECONSTRUCTIVE SURGERY IN ELDERLYPATIENTS
J. VLACIL, O. SOTTNER, K.MAXOVA, M. KOTOULOVA, M. HALASKA;
Dpt. of OB/Gyn, Hospital NaBulovce, Charles Univ. in Prague, Prague, Czech Republic.
Introduction: Traditionalsurgical method for solving anterior vaginal wall descent is ananterior colporrhaphia, which is consist of central plication ofendopelvic fascia and fibromuscular layer of the anterior vaginalwall. Because of the many associated diseases in the gerontologicalpopulation it is really attractive to eliminate side effects of aspinal and a general anesthesia using a local anesthesia.
Objective:To evaluate the advantage of the usage of local anesthesia forvaginal surgery in a large group of the gerontologicalpatients.
Methods: 129 patients aged over 60 with diagnoseddescent of anterior vaginal wall G II - III according toInternational Continence Society (ICS) classification, were includedinto the study between years 2013-2016. They were informed aboutpossibility of a local and a general anesthesia. After that, signedinformed consent. They underwent anterior vaginal wall repair in thesole local anesthesia, which was applied above endopelvic fascia.After urethrovesical space preparation - asking frequently thefeedback of the patient concerning any pain - we harvested the fasciafrom the wall laterally and used it for the anterior colporrhaphy.For the assessment of the procedure, we used subjective figures,Visual analogue scale (VAS), Verbal descriptor pain intensity scaleand quality of life questionnaires International Consultation onIncontinence Questionnaire - Short Form (ICIQ-SH), Pelvic FloorDistress Inventory - 20 (PFDI-20).
Results: We registeredpositive influence of local anesthesia. Subjective perception of painaccording to VAS is shown in Table 1. Moreover, we foundstatistically significant improvement of both the urinaryincontinence and the subjective perception of descent.
Conclusions:Excellent subjective assessment of usage of a local anesthesia showedus new operative possibility in treatment applicable in high-riskpatients.
References: Gynecol Obstet Invest2001;51(3):184-6.Minerva Ginecol 2017 Feb;69(1):18-22.
Table1: Patient subjective perception of pain