Abstract No: 28
ANESTHESIA REGIMEN FOR IN-OFFICE USE OF THE NOVASURe-trademark
IMPEDANCE CONTROLLED ENDOMETRIAL ABLATION SYSTEM
P. Laberge
C.H.U.Q. Pavillon CHUL, Saint-Foy, Canada
The use of the new Global endometrial ablation technologies in an office setting has been
the focus of heated discussions for a number of years now. Physicians are facing a
challenging task of not only identifying the ablation technology to be employed, but also
developing the appropriate protocol for anesthesia that can be applied in an office setting.
There are number of factors that are believed to cause pain during the endometrial
ablation, including the level of cervical dilation, distension of the uterine cavity, and length
of the procedure. After careful evaluation of all the Global endometrial ablation systems,
we decided that NovaSure would have the highest chance of success in being used in an
office setting. The fact that NovaSure does not require significant cervical dilation (7.5
mm), the treatment time is extremely short (approx. 90 seconds), and the technology does
not require distension of the uterine cavity, allow this system to be considered as a
treatment modality of choice in an office setting. After initial evaluation in an OR setting,
where a number of different anesthesia protocols were employed, we were able to
conclude that this procedure could be performed in an office setting using an anesthesia
protocol consisting of a combination of a Para-Cervical Block (PCB) and IV sedation. Our
routine anesthesia protocol is as follows: 1. One hour before the procedure the patient is
administered 100 milogram of Indomethacin in the form of a rectal suppository plus 1g of
acetaminophen per os. 2. PCB is performed using intra-cervical injection of Xylocaine 2
percent at 2, 4, 7, and 10 o'clock. The injection is performed deep into the cervix to the
level of the internal cervical os. Two more injections are applied into the utero-sacral
ligaments. The amount of Xylocaine has to be calculated and should be no less than: Body
Mass (kilogram) / 10 equals cc of 2 percent Xylocaine This amount (or more) should be
diluted in saline up to a volume of 20cc or more and then used as described above. It is
imperative for the success of the procedure that the physician allow at least 5-7 minutes for
the PCB to take effect. 3. About 3-5 minutes before the procedure, the patient receives 50
mcg of Fentanyl (IV), followed by the second dose of 50 mcg of Fentanyl just before the
device is inserted. Based on extensive experience, it was demonstrated that endometrial
ablation can be successfully accomplished in an office setting when the NovaSure system
is used with a combination of PCB and IV sedation.