Low cost, patient acceptable, local analgesia approach to gynaecological outpatient surgery. A review of 817 consecutive procedures

Abstract

The objective of this study was to evaluate safety, cost effectiveness and patient acceptability, of performing a wide variety of gynaecological procedures, including endometrial resections, in a clinic using only local analgesia. Eight hundred and seventeen consecutive gynaecological procedures were performed under local analgesia only, with no sedation, including endometrial resections, cone biopsies, terminations of pregnancy, hysteroscopies, and local vaginal and plastic vulval procedures, as well as many combined procedures (figure 1) in a day-surgery ward annexe in the Department of Gynaecology, St John's District General Hospital, Chelmsford Essex. The main outcome measures were patient acceptability, safety and encountered side-effects of procedures performed under local analgesia as well as evaluation of cost-effectiveness and reduction in theatre waiting list times. A high degree of safety and patient acceptability was achieved, with other considerable benefits being short waiting times and much quicker recovery. The only complications were from the endometrial resection group, with only 8 (3.6%) of these requiring intravenous sedation intraoperatively, and 6 (2.7%) requiring overnight admission. No transfers to theatre during any procedure occurred. Savings per procedure, in cost and in patient's time, were very considerable.

Conclusion: The local analgesia approach for a wide variety of gynaecological procedures in a combined outpatient theatre is safe and is highly acceptable to patients. There are also considerable benefits in cost and patient convenience, with a reduction in operating list waiting time, which in the current economic climate are worth considering.