Randomized comparison of local versus epidural anesthesia for tension-freevaginal tape operation

Purpose: We determine the difference between local anesthesia and epidural blockade for the tension-free vaginal tape operation. Materials and Methods: Between November 1995 and November 1997, 73 women wh o had genuine stress incontinence in the absence of pelvic prolapse underwe nt a prospective randomized study. The study was conducted using a standard ized protocol for different types of anesthesia for the tension-free vagina l tape procedure. A formal pain scale was used to determine the pain score for the patients during the operation. Additionally an anxiety scale was us ed to measure the anxiety level of the subjects immediately after admission to the ward and before discharge from the hospital. Results: One woman was excluded from study due to loss at followup. The com parisons of pain score, duration of procedure and anxiety level of the 2 di fferent types of anesthesia were not significantly different in the 72 stud y subjects. There was no significant difference in the amount of blood loss , while initial spontaneous voiding occurred significantly earlier (3.5 +/- 2.3 versus 5.8 +/- 0.1 hours, p < 0.01), the number of patients in whom in itial spontaneous voiding occurred more than 6 hours postoperatively was fe wer (2 versus 10, p = 0.01), amount of post-void residual during hospitaliz ation was significantly less (98 <plus/minus> 63 versus 155 +/- 56 mi., p < 0.01) and length of hospital stay was significantly shorter (3.4 <plus/min us> 1.4 versus 5.5 +/- 1.6 days, p < 0.01) in the local anesthesia compared to epidural group. Subjective and objective success rates were not signifi cantly different in these 2 groups. Conclusions: Both anesthetic methods can be equally effectively used for th e tension-free vaginal tape operation. Local may be better than epidural an esthesia but its clinical significance needs to be proved by further study.