多部位局部麻醉下MyoSure宫腔镜子宫内膜息肉机械旋切术

Multisite Local Anesthesia for MyoSure Hysteroscopic Morcellation of Endometrial Polyps

目的探讨局部麻醉用于MyoSure宫腔镜子宫内膜息肉机械旋切术的安全性及可行性。方法2021年4~5月行局部麻醉下MyoSure宫腔镜子宫内膜息肉旋切术日间手术30例,查体宫颈质地坚韧者术前15 min静脉滴注间苯三酚40~80 mg。采用多部位局部麻醉,包括5%复方利多卡因乳膏阴道黏膜及颈管黏膜表面麻醉,0.5%罗哌卡因宫颈及宫颈旁阻滞麻醉,2%利多卡因宫腔黏膜表面麻醉。结果30例中仅3例(10%)需扩张宫颈,手术均顺利完成,未出现因疼痛难忍需中转全身麻醉者,无迷走神经反射及并发症发生。术中局麻药物相关不良反应包括耳鸣5例,头晕1例,均于2 min内消失;未出现过敏反应及其他不良反应。患者对镇痛效果满意度100%(非常满意28例,满意2例)。结论多部位局部麻醉技术应用于MyoSure宫腔镜子宫内膜息肉机械旋切术安全可行,患者满意度高,可用于日间手术。

Objective To investigate the safety and feasibility of MyoSure hysteroscopic morcellation of endometrial polyps under local anesthesia.Methods Clinical data of 30 patients underwent day surgery of MyoSure hysteroscopic morcellation of endometrial polyps under local anesthesia from April to May 2020 were collected.If the cervix was found tough,the phloroglucinol 40-80 mg was administered intravenously 15 min before operation.Multisite local anesthesia was used,including vaginal mucosa and cervical mucosa surface anesthesia with 5%compound lidocaine cream,cervical and paracervical block anesthesia with 0.5%ropivacaine,and uterine mucosa anesthesia with 2%lidocaine.Results Among the 30 patients,only 3 cases(10%)needed cervix dilation.All the operations progressed smoothly without vagal reflex and complications.No patient needed general anesthesia due to severe pain.Local anaesthesia related adverse reactions included tinnitus in 5 cases and dizziness in 1 case,all of which disappeared within 2 min.No serious allergic reactions or other adverse reactions occurred.The patient satisfaction about analgesic effect was 100%(28 cases very satisfied and 2 cases satisfied).Conclusions The application of multisite local anesthesia technique in MyoSure hysteroscopic morcellation of endometrial polyps is safe and feasible,with high level of patient satisfaction.It can be used in day surgery.