ESRA19-0391 Conscious sedation combined with local anaesthesia for vaginal hysterectomy: a pilot study

Background and aims Several studies have suggested numerous advantages of local anaesthesia over both regional and general anaesthesia techniques. the aim of this study was to evaluate and describe the safety and feasibility of performing vaginal prolapse surgery under local anaesthesia and conscious sedation using dexmetomidine. Methods We studied 19 patients ASA II-III, aged 55–80 years old undergoing surgical repair for vaginal prolapse under conscious sedation and local infiltration with pudendal nerve block. All patients were premedicated with midazolam 0.02 mg/kg and a bolus dose of 1μg/kg dexmedetomidine for 10 minutes followed by an infusion of 0.7–1 μg/kg/h. the anaesthetic solution consisted of 20 ml lidocaine 2% and 40 ml ropivacaine 0.5% in 1:200000 adrenaline. Hemodynamic variables, pain (Visual Analogue Scale 0–10) and sedation (Ramsay Scale) were recorded during surgery. Postoperative pain, analgesia requirements, nausea, vomiting, sedation (10-cm VAS) and patient satisfaction were also assessed. Results One patient was converted to general anaesthesia. Pain intensity at rest and the level of sedation at 2, 8, 12 and 24 hours postoperatively were 0, 0.3±0.8, 0.8±1.9, 0.5±1.1 and 4.3±1.3, 2.8±1.8, 2±1.2, 1.2±0.7, respectively. All patients were fully mobilised within 3 hours and very satisfied with the type of anaesthesia. No adverse events such as bradycardia or hypotension were noted. Conclusions Surgical correction of vaginal prolapse can be performed safely and effectively using local anaesthesia and pudendal nerve block under conscious sedation with dexmedetomidine as it seems to provide efficient hemodynamic stability, high Ramsey scores and high satisfaction scores in these patients.