Deep Sedation or Paracervical Block for Daycare Gynecological Procedures: A Prospective, Comparative Study

Nishant Sahay; Mukta Agarwal; Mamta Bara; Nutan Raj; Divendu Bhushan

doi:10.4103/GMIT.GMIT_12_19

Deep Sedation or Paracervical Block for Daycare Gynecological Procedures: A Prospective, Comparative Study

Gynecol Minim Invasive Ther. 2019 Oct 24;8(4):160-164. doi: 10.4103/GMIT.GMIT_12_19. eCollection 2019 Oct-Dec.

Authors

Nishant Sahay¹, Mukta Agarwal², Mamta Bara¹, Nutan Raj², Divendu Bhushan³

Affiliations

¹ Department of Anesthesiology, AIIMS, Patna, Bihar, India.
² Department of Obstetrics, AIIMS, Patna, Bihar, India.
³ Department of General Medicine, AIIMS, Patna, Bihar, India.

Abstract

Context: Many minor gynecological procedures are done for diagnostic and therapeutic reasons. A balance has to be struck between ability to discharge a patient at the earliest with minimum procedure-related discomfort to ensure patient safety as well as satisfaction.

Aim: This prospective randomized study was designed to compare deep sedation versus paracervical block for minor gynecological surgeries comparing the time to discharge readiness, pain after the procedure, and overall patient satisfaction.

Setting and design: This prospective randomized comparative study was conducted at a tertiary level hospital after institutional ethics committee approval and registry of trial at CTRI (India).

Methods: Seventy young women underwent minor gynecological procedures under these two modes of anesthesia. Time to discharge readiness from hospital to home was assessed using modified postanesthesia discharge score system (PADSS). Pain after procedure as well as patient satisfaction was evaluated. Patients were also asked whether they would recommend the same anesthetic technique for the procedure in the future. Answers were noted on a Likert scale.

Results: Patients were ready to be discharged faster in deep sedation group compared to paracervical block group based upon modified PADSS score (1 h 9.6 min vs. 1 h 18 min) (P = 0.005). Pain in the perioperative period was analyzed using repeated-measures ANOVA and found to be significantly lesser in deep sedation group when considered till 80 min after surgery. The mean satisfaction score in patients who underwent deep sedation was 91.24 (standard deviation [SD] 2.8) compared to patients given paracervical block which was low at 64.67 (SD 15.8). All patients given deep sedation were ready to recommend the anesthesia technique as compared to only 53.3% of patients who were given paracervical block.

Conclusions: Deep sedation may be preferred over paracervical block for daycare minor gynecological procedures.

Keywords: Deep sedation; discharge; paracervical block; patient satisfaction.