Intracervical Anasthesia in Outpatient Hystroscopy, Can Procedure be Completed Diagnostic and Therapeutic With no Need to General Anaesthesia

Procedures:

All patients were subjected to:

• History taking
• Verbal consent to participate in our study
• Patient put in lithotomy position
• Casco speculum was applied exposing the cervix
• Betadine sterilization of the cervix then properly washed with saline as heavy metals of disinfectant may cause irritation with injection
• Multiple toothed volselum was used just to fix cervix
• 3 cartridges of mepivacaine hydrochloride was filled in 10 mi syringe
• Do aspiration to exclude and avoid intravascular injection then infilterate slowly intracervical at both 3 and 9 positions
• Instruments are removed and at least 5 minutes later procedure started.
• Hystroscopy (rigid , 2.9 mm sheath) was introduced gently throw vaginoscopy exploring vagina , cervix and uterine cavity
• Patient was monitored for pain all through the procedure by descriptive scale, mild, moderate and severe. ( moderate who needed to take rest then continue , severe that necessitated interruption of the procedure
• All patients were monitored for signs of vaso vagal attack as sings (low blood pressure and bradycardia) before and if needed during. Occurrence of symptoms as pallor , sweet and fainting
• All patients were monitored post procedure for persistence of colicky pain

Inclusion criteria

• must be under 40 years
• must be no history of renal or hepatic disease
• must be no known hypersensitivity to local anaesthetic agents
• must be no significant vaginal or cervical infection.

Exclusion criteria

• All patients with history of sever vasovagal attack during any gynecological procedures.