Recurrent Dysplasia After a Loop Electrosurgical Excision Procedure: Local Versus General Anesthesia

Tzur, Yossi; Berkovitz-Shperling, Roza; Laskov, Ido; Grisaru, Dan; Michaan, Nadav

doi:10.1097/lgt.0000000000000692

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…In our study, cone height and volume were close to the ideal cut-off values and were similar between the groups. A recent retrospective study including 146 women who underwent LEEP using GA or LA demonstrated that the type of anesthesia did not affect the surgical margins after the procedure 21 . Similarly, we demonstrated in a multivariate analysis that the mode of anesthesia does not influence the surgical margins.…”

Section: Discussionsupporting

confidence: 74%

Influence of General and Local Anesthesia on Postoperative Pain After a Loop Electrosurgical Excision Procedure

Güngördük,

Türkmen,

Gülseren

et al. 2023

J Low Genit Tract Dis

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Objective: To compare patient satisfaction, histopathologic results, and short-term morbidity in patients undergoing loop electrosurgical excision procedure (LEEP) under local anesthesia (LA) versus general anesthesia (GA).Methods: Participants who met the inclusion criteria were randomly allocated in a 1:1 ratio to the LA group or GA group. Pain was determined by both objective (faces pain scale-revised) and subjective (visual analog scale score) methods.Results: Data from 244 patients (123 in the LA group and 121 in the GA group) were analyzed. The median cone volume was 2.0 (0.4-4.7) cm 3 in the LA group and 2.4 (0.3-4.8) cm 3 in the GA group. There was no difference in margin involvement or repeat conization between the groups. The procedure time, time to complete hemostasis, intraoperative blood loss, and early postoperative blood loss were similar between the groups. The visual analog scale scores were higher in the LA group at 1, 2, and 4 hours postoperatively, but the differences between the groups were not significant. In addition, the median faces pain scale-revised scores at 1, 2, and 4 hours postoperatively were not significantly different between the LA and GA groups. Conclusions:The present study showed no difference in pain during the postoperative period, need for additional analgesia, volume of the extracted cone specimens, rate of positive surgical margin, bleeding volume, or operation time in women undergoing loop electrosurgical excision procedure under LA versus GA.

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Section: Discussionsupporting

confidence: 74%

Influence of General and Local Anesthesia on Postoperative Pain After a Loop Electrosurgical Excision Procedure

Güngördük,

Türkmen,

Gülseren

et al. 2023

J Low Genit Tract Dis

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“…The same applies to the diagnosis of an HSIL in the first 2 years after LEEP by biopsy (4.2 % vs. 1.3 %) or repeat LEEP (7.0 % vs. 9.3 %). The authors conclude that the anaesthetic technique of choice for a LEEP should be LA [14].…”

Section: Discussionmentioning

confidence: 96%

“…Gleiches gilt für die Diagnose einer HSIL in den ersten 2 Jahren nach LEEP mittels Biopsie (4,2 % vs. 1,3 %) oder Re-LEEP (7,0 % vs. 9,3 %). Die Autoren folgern, dass für LEEP LA das Anästhesieverfahren der Wahl sein sollte [14].…”

Section: Diskussionunclassified

Loop Excision for Precancers of the Uterine Cervix: Local or General Anaesthetic?

Freisleben,

Petzel,

Jülicher

et al. 2023

Geburtshilfe Frauenheilkd

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In Germany, treatment of HSIL or AIS of the uterine cervix by loop excision is performed almost exclusively under general anaesthesia (GA). International studies and guidelines show high acceptance of local anaesthesia (LA) due to hermeneutic, medical, and economic factors. We performed an observational comparative study aiming to prove advantages of local anaesthesia within the German health system.In a prospective observational study, patients diagnosed with HSIL or AIS of the uterine cervix were treated at the Institute for Cytology and Dysplasia, Berlin, by loop excision in 2021. We started with a feasibility study: 303 patients diagnosed with HSIL/AIS of the uterine cervix and her colposcopist answered an electronic questionnaire with respect to loop excision under LA.Since we found a high acceptance for LA in patients and colposcopists, we initiated a comparative study LA vs. GA: 322 patients underwent loop excision and selected their mode of anaesthesia: n = 206 LA vs. n = 116 GA. 114 patients of the feasibility study had to undergo loop excision and became part of the comparative study (n = 79 for the LA group, n = 35 for the GA group). All patients received a standardised questionnaire to document their pain score within 24 h after treatment on a visual analogue scale, i.e. VAS, between 0 and 100. 178 patients of the LA group and 80 patients of the GA group completed and returned the questionnaire and form the cohort for our comparison of LA vs. GA. With 191 of these 258 patients, i.e. 74%, a telephone survey was performed to ask for patient satisfaction and the rates of recurrence after a mean interval of 1 year post surgery. We postulate that there will be no clinically relevant significant difference in satisfaction and postoperative pain between patients in the LA group and the GA group.In the feasibility study, 90% (272 of 303) of patients diagnosed with HSIL or AIS were considered eligible for LA by their colposcopists. 75% (227 of 303) of patients were open to loop excision under LA.In the comparative study, 63 of 206 women of the LA group were interviewed preoperatively: 89% would accept a pain score above 20 during the procedure, 33% a pain score above 50 and 11% of max. 20. Postoperatively, the median VAS pain score for loop excision under local anaesthesia was 13.1 in 178 patients, and pain during injection of local anaesthesia was 20.9 (p < 0.001). The VAS pain score 20 minutes post surgery did not differ significantly between 178 patients after local anaesthesia versus 80 patients after general anaesthesia (p = 0.09). The surgeons estimated the patient’s pain significantly less than the patients themselves with an underestimate of −14.63 points on the VAS (p < 0.001).Within 7 days following loop excision under LA, 95.5% of 178 patients would choose local anaesthesia as their preferred method for a potential repeat loop excision, 8.8% of which would like additional painkillers, and 4.5% would choose general anaesthesia.In a telephone follow-up survey of 133 women from the LA group after a mean of 12 months post surgery, 97% were “satisfied” or “very satisfied” with the treatment carried out. For patient satisfaction and postoperative pain, no clinically relevant significant difference was seen between the LA and the GA group.The rate of secondary bleeding (6.7% vs. 8.1%, p = 0.72), recurrence of HSIL/AIS (3.6% vs. 5.2%, p = 0.62), and the distribution of the histopathological R status (R0 89.5% vs. 81.1%, p = 0.73; R1 5.3% vs.12.2%, p = 0.57, Rx 4.1% vs. 5.4%, p = 0.65) showed no significant difference when comparing the LA group versus the GA group.Following loop excision under local anaesthesia, more than 95% of patients would choose this method again for repeat surgery. One year post surgery, 97% of the patients were “satisfied” or “very satisfied” with the treatment under local anaesthesia. Offering local anaesthesia for loop excision to patients should be mandatory and included in current guidelines.

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“…The safety and efficacy of LEEP under local anesthesia have been documented in many studies [6, 7]. Postoperative pain, postoperative bleeding, infection, and the margin status of the resected specimen did not differ significantly between the clients who underwent LEEP under local versus general anesthesia [6–9]. In fact, the local anesthesia group had fewer bleeding complications and higher overall satisfaction [6, 7, 9].…”

Section: Introductionmentioning

confidence: 99%

Addressing cervical cancer prevention in Bhutan: A study on the use of loop electrosurgical excision procedures at the primary health care level

Tshering,

Dorji,

Letho

et al. 2024

Public Health Challenges

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BackgroundCervical cancer is the top and fourth leading cause of death among women in Bhutan and worldwide, respectively. The cervical cancer elimination flagship program initiated by the Ministry of Health aims to achieve the 90–70–90 goals by 2030. To achieve this, detection and treatment of pre‐cancerous lesions of the cervix through colposcopy and loop electrosurgical excision procedure (LEEP) are being carried out through the outreach health camps.MethodsThis descriptive study aimed to assess the safety and tolerability of LEEP under local anesthesia and assess the margin status of high‐grade lesion (HGL). We analyzed 193 records of clients who underwent LEEP at Wangdue Phodrang Hospital from 26 September to 5 October 2022. The sociodemographic profile, intraoperative pain, complications, and histopathological reports were described using structured pro forma.ResultsThe mean age of clients was 40.9 ± 8.5 years (range 25–66 years). There were 3.1% who had intraoperative and 2.6% who had postoperative bleeding. There were 18.6% who had foul‐smelling vaginal discharge, and 8.3% had moderate‐to‐severe intraoperative pain. Histopathological assessment revealed 29.5% with chronic cervicitis, 34.2% with HGL, and 1.6% with microinvasive cervical carcinoma. The margin positivity for HGL was 36.4%.ConclusionGiven the safety profile of LEEP under local anesthesia in our setting, the scope of providing a complete cervical cancer screening and treatment package at the primary health care level looks promising. Based on the higher rate of overtreatment and margin positivity, we recommend the practical implementation of standard colposcopy guidelines.

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Recurrent Dysplasia After a Loop Electrosurgical Excision Procedure: Local Versus General Anesthesia

Cited by 5 publications

References 18 publications

Influence of General and Local Anesthesia on Postoperative Pain After a Loop Electrosurgical Excision Procedure

Influence of General and Local Anesthesia on Postoperative Pain After a Loop Electrosurgical Excision Procedure

Loop Excision for Precancers of the Uterine Cervix: Local or General Anaesthetic?

Addressing cervical cancer prevention in Bhutan: A study on the use of loop electrosurgical excision procedures at the primary health care level

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