LOW-COST, PATIENT ACCEPTABLE, LOCAL ANALGESIA APPROACH TO GYNECOLOGICAL OUTPATIENT SURGERY A REVIEW OF 817 CONSECUTIVE PROCEDURES

The objective of this study was to evaluate safety, cost effectiveness and patient acceptability, of performing a wide variety of gynaecolog ical procedures, including endometrial resections, in a clinic using o nly local analgesia. Eight hundred and seventeen consecutive gynaecolo gical procedures were performed under local analgesia only, with no se dation, including endometrial resections, cone biopsies, terminations of pregnancy, hysteroscopies, and local vaginal and plastic vulval pro cedures, as well as many combined procedures (figure 1) in a day-surge ry ward annexe in the Department of Gynaecology, St John's District Ge neral Hospital, Chelmsford Essex. The main outcome measures were patei nt acceptability, safety and encountered side-effects of procedures pe rformed under local analgesia as well as evaluation of cost-effectiven ess and reduction in theatre waiting list times. A high degree of safe ty and patient acceptability was achieved, with other considerable ben efits being short waiting times and much quicker recovery. The only co mplications 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 t ime, were very considerable. Conclusion: The local analgesia approach for a wide variety of gynaecological procedures in a combined outpatie nt theatre is safe and is highly acceptable to patients. There are als o considerable benefits in cost and patient convenience, with a reduct ion in operating list waiting time, which in the current economic clim ate are worth considering.