Microwave endometrial ablation (MEA) is a procedure used to treat heavy menstrual bleeding. This study aimed to compare patient acceptability and recovery outcomes when MEA is performed under local anesthesia with sedation versus general anesthesia.
This research was structured as a prospective randomized controlled trial conducted in a UK teaching hospital’s gynecology department. Participants included women referred for MEA without specific medical indications favoring one type of anesthesia over the other. A total of 191 women were randomly assigned to receive either general or local anesthesia for their MEA procedure. Data was also collected from women who had a preference for anesthesia and declined randomization. All procedures were performed in an operating theater setting. The study utilized questionnaires to gather data on patient-reported treatment acceptability, operative details, and post-operative recovery experiences.
The results indicated that a significant majority (69%) of eligible women would consider undergoing MEA with local anesthesia. Importantly, in 91% of cases where local anesthesia was initially administered, the MEA procedure was successfully completed without needing to switch to general anesthesia. Interestingly, whether anesthesia type was determined by randomization or patient preference did not significantly impact the proportion of women who rated the treatment as generally or totally acceptable after two weeks. Factors like parity or uterine cavity size also did not predict treatment acceptability. However, patients who received general anesthesia were more inclined to describe the procedure as totally acceptable and express a preference for general anesthesia if they were to undergo the procedure again. There was no significant difference observed between the two anesthesia groups in terms of post-operative pain levels, nausea, or recovery time.
In conclusion, the study demonstrates that microwave endometrial ablation under local anesthesia is acceptable to most women who are candidates for this treatment. However, it is crucial to note that local anesthesia did not offer a recovery advantage compared to general anesthesia. Furthermore, a notable proportion, almost 10%, of women initially undergoing MEA with local anesthesia required conversion to general anesthesia due to discomfort. The reported incidence of post-operative pain and nausea suggests that even with a local anesthesia and sedation approach, MEA remains a day-case procedure rather than being suitable for outpatient settings.
