Office tubal sterilization

Abstract

We retrospectively studied 57 cases of laparoscopic bilateral tubal ligation (BTL) performed under local anesthesia at the obstetrics and gynecology outpatient center of Winthrop-University Hospital, between May 1987 and November 1992. The mean age of our patients was 34.3+10.22 years and the weight ranged between 48 to 109 kg. Contraindications included history of bleeding diathesis, severe cardiac disease, grand mal epilepsy, or unusually high anxiety level of the pt. All women were premedicated with Anaprox 500 mg po 30 minutes before the procedure. Local anesthesia was administered as follows: paracervical block; periumbilical and suprapubic injection with 1% lidocaine (10 ml); and intrauterine infusion of 4% lidocaine (5-6 ml). Insufflation of the peritoneal cavity was performed with 1 to 2 L nitrous oxide. We used a 7-mm clip applicator for the BTL. The mean operative time was 34.7 minutes. The reduction of cost compared with the same procedure performed under general anesthesia was 40%. No major complications or hospitalizations occurred. Eighty-five percent of the women expressed a high degree of satisfaction when questioned about the procedure. We conclude that office tubal sterilization under local anesthesia is safe and acceptable to both patients and physicians, offering reduced cost, elimination of general anesthesic complications, rapid recovery, and accommodation of patient preference and physician convenience.