Obstet Gynecol Sci.  2017 Jan;60(1):87-91. 10.5468/ogs.2017.60.1.87.

Delayed hemorrhage effect of local anesthesia with epinephrine in the loop electrosurgical excisional procedure

Affiliations
  • 1Institute of Women's Life Medical Science, Women's Cancer Clinic, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea. nahmej6@yuhs.ac

Abstract


OBJECTIVE
The aim of this study was to investigate factors preventing delayed hemorrhage after the loop electrosurgical excisional procedure (LEEP).
METHODS
Medical records of patients who underwent LEEP at one university affiliated hospital from October 2013 to January 2015 were reviewed. Patients with or without delayed hemorrhage were classified. LEEP was performed either in an operating room under general anesthesia or in a procedure room with local anesthesia in the outpatient clinic. Delayed hemorrhage was defined as excisional site bleeding occurring between 1 and 30 days after the LEEP requiring intervention such as electro-cauterization, gauze packing, or application of another hemostatic agent.
RESULTS
During the study period, 369 patients underwent LEEP. Twenty-three (6.2%) patients with delayed hemorrhage returned to our hospital either to the outpatient clinic or to the emergency unit. A third of the population (103, 27.9%) underwent LEEP in the operating room under general anesthesia without injection of local anesthesia. The remaining patients (266, 72.1%) underwent LEEP with local anesthesia (lidocaine HCl 2% with epinephrine 1:100,000) in the office procedure room. Patients given local anesthesia including epinephrine had significantly lower delayed hemorrhage compared to patients with general anesthesia without injection of local anesthesia (P=0.001). Hemostats, such as fibrin glue or patch, were used for the majority of patients (346, 93.8%) during the procedure. However, using hemostats was not statistically associated with delayed hemorrhage (P=0.163).
CONCLUSION
Local anesthesia with the powerful vasoconstrictor epinephrine is effective not only to control perioperative bleeding, but also to prevent delayed hemorrhage after LEEP.

Keyword

Anesthesia, local; Delayed hemorrhage; Loop electrosurgical excisional procedure

MeSH Terms

Ambulatory Care Facilities
Anesthesia, General
Anesthesia, Local*
Emergency Service, Hospital
Epinephrine*
Fibrin Tissue Adhesive
Hemorrhage*
Humans
Medical Records
Operating Rooms
Epinephrine
Fibrin Tissue Adhesive

Figure

  • Fig. 1 Local anesthesia injection site of cervix.


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