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Re: Analgesia for Vag Hysts From: Barbara Nicol MD (blnicol@ix.netcom.com) Tue Sep 9 15:01:42 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: OCP question" Previous message: Richard Chudacoff, MD: "Re: Urinary stress incontinence and estrogen" Next in thread: Gail Waldby: "Re: Analgesia for Vag Hysts" Reply: Gail Waldby: "Re: Analgesia for Vag Hysts" For several years I have used lidocaine 1 percent with epinephrine paracervically prior to my initial incision at vaginal hysterectomy, for two reasons: (1) Nichols says to do so in his excellent textbook on vaginal surgery (although as I look at the (4th ed) chapter again I note that this recommendation is based largely on personal experience and remains unencumbered by much data). (2) I have read a few papers from other surgical fields about preemptive analgesia - infiltrating local in the incision site prior to rather than after incision -- improving pain control outcomes in other types of surgery, although only where there is general rather than conduction anesthesia. If you are generally doing your VHs under spinal/epidural I would imagine there would be no difference in pain outcomes. If one is going to use local at all, it makes more sense to me to use it prior to incision - preemptively - and in the paracervical tissues (which have most of the pain fibers) rather than in the vascular pedicles after they've been cut. (Perhaps the anesthesiologist didn't know exactly what the UW folks are infiltrating when?) For abdominal procedures, I infiltrate the incision site with marcaine (unless the patient has a conduction-type anesthetic) prior to starting. I don't feel very comfortable using marcaine in the paracervical block because I think that the possibility of intravascular injection/absorption is higher in that setting, even using a control-grip syringe and aspiration. If I'm going to accidentally inject an anesthetic intravascularly, I'd way rather have it be lidocaine because the cardiac side effects would be much briefer. Maybe I'm being overly conservative on this point, however, since the dosages are small and it's unlikely that anyone would put a large dose into a vessel without noticing. The epi really helps keep the field dry during the case, too. Barb Nicol At Fri, 5 Sep 2003, Lynn D. Montgomery, M.D. wrote: > >Heh y'all, >Another new one on me today. I was just about to begin a vag hyst when >the anesthesiologist asked me if I was going to use the "new" technique >of injecting the pedicles, as I did my hyst, with local anesthetic. I >said "say what". He then told me that because of difficultly >encountered in controlling postoperative pain following a vaginal >hysterectomy "several" gynecologists were using this technique. When I >asked for references, he simply told me that it came from the University >of Washington. > -- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA Next message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: OCP question" Previous message: Richard Chudacoff, MD: "Re: Urinary stress incontinence and estrogen" Next in thread: Gail Waldby: "Re: Analgesia for Vag Hysts" Reply: Gail Waldby: "Re: Analgesia for Vag Hysts"

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