Hysteroscopy

Summary

  • Dose: 1.5 ml (7.5 mg) 0.5% hyperbaric bupivacaine + 15 mcg fentanyl

  • Position: Sitting, immediately supine. Lithotomy when block T12.

  • Expectation: Surgical anaesthesia for up to 30 minutes.

Evidence

  • 5 mg 0.5%hyperbaric bupivacaine plus 10 mcg fentanyl (patient lateral, then sit for 10 min, then supine) was used for procedures lasting ~ 15 minutes [1]. However, 4.3% of patients complained of intraoperative pain.

  • 7.5 mg hyperbaric bupivacaine was used (patient sitting, immediately supine) in short (< 60 min) procedures (17% of which were gynaecological – hysteroscopy, D&C, vulvar or vaginal biopsy [2]. Surgery was 20 minutes on average. Blocks peaked at ~T7 and 9% of patients (not specifically gynaecological) required intraoperative analgesia, and no one required GA.

References

  1. Low dose spinal anaesthesia with hyperbaric bupivacaine with intrathecal fentanyl for operative hysteroscopy: A case series study. J of Minimally invasive Gynaecology 2012;19(1):107-112.

  2. Lacasse et al. Comparison of bupivacaine and 2-chloroprocaine for spinal anesthesia for outpatient surgery: a double-blond randomised trial. CJA 2011;58:384-391