Dr Mary Stocker, Consultant Anaesthetist
Mr Naru Narayanan, Consultant Gynaecologist
Torbay and South Devon NHS Foundation Trust

Patient Selection

• All women who need surgical treatment of prolapse
• No exceptions
• All surgeons working to the same protocol

Anaesthetic Techniques

• General or Spinal Anaesthesia
• General Anaesthesia
  
  • Induction and maintenance with target controlled propofol and alfentanil infusions.
  • Spontaneous ventilation with Laryngeal Mask Airway
• Spinal Anaesthesia
  
  • 3mls 2% hyperbaric prilocaine
• All Cases
  • Always give 1 litre crystalloid as this reduces PONV and dizziness: usually do not need more than this.
  • IV Dexamethasone 6.6mg and ondansetron 4mg iv for hysterectomies
  • Anti-emetic medication is not routinely required for vaginal repair surgery
  • Subcutaneous fragmin 5000u at end of procedure if >60 minutes

Surgical Technique

• Lithotomy position.
• Infiltration with 0.25% Bupivacaine and 1:200000 adrenaline. 20mls per compartment.
• If hysterectomy, then I use finger switch diathermy to make incisions.
• I ensure meticulous haemostasis.
• Mostly 3 pedicle hysterectomy
• If uterine size more than 12 weeks pregnancy size, then I will bisect the uterus after taking the uterine pedicle to make it easier to place a clamp around the cornual pedicles.
• No pack and no catheter as routine.

Peri-operative Analgesia

• Pre-medication with oral Ibuprofen Retard 1600mg and Paracetamol 1g.
• Intra-operative iv fentanyl 25mcg prn.
• Post-operative iv fentanyl prn, then oramorph and regular paracetamol.

Take Home Medication

• Paracetamol 500 mg/ codeine 30mg po qds, laxido 1 sachet bd, plus ibuprofen 400 mg po qds

Anticipated Day Case Rates

• > 80%