Vaginal Hysterectomy

Summary

  • Dose: 3 ml 0.5% hyperbaric bupivacaine + 15 mcg fentanyl.

  • Position: Patient sitting, immediately supine, lithotomy when block T10.

  • Expectation: Surgical block for up to 120 minutes post-spinal.

Evidence

  • The GOSSIP study started with the use of 5 mg 0.5% hyperbaric bupivacaine with 10 mcg fentanyl, however, owing to sub-optimal pain control, increased the dose. Ultimately 10 mg 0.5% hyperbaric bupivacaine with 10 mcg fentanyl (diluted to 3 ml with NaCl 0.9%, injected sitting, immediately semi-recumbent) was used successfully in 80% of patients undergoing tapes, vaginal repairs or hysterectomy [1]. Operating times were ~42 minutes and ~ 75 minutes for tapes/vaginal repair and hysterectomy respectively.

References

  1. Purwar et al. General or spinal anaesthetic for vaginal surgery in pelvic floor disorders (GOSSIP):  a feasibility randomised controlled trial. Int Urogynecol J 2015;26:1171-1178.