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Patient-controlled sedation for outpatient thermal balloon endometrial ablation
Ingrid Hung Lok1, Matthew Chan, Wing Hung Tam
1Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Study Objective:
To evaluate the effectiveness, safety, and patient satisfaction with patient-controlled sedation during thermal balloon endometrial ablation.
Design:
Prospective observational study (Canadian Task Force classification II-2).
Setting:
University-affiliated teaching hospital.
Patients:
Thirty consecutive women with idiopathic menorrhagia refractory to medical treatment.
Intervention:
Thermal balloon endometrial ablation under patient-controlled sedation with a mixture of propofol and alfentanil through an analgesia pump.
Measurements And Main Results:
Pain was assessed using a descriptive pain score and the procedure was divided into four stages for assessment: catheter insertion, preheating phase, treatment cycle, and end of treatment. Patient satisfaction was assessed using the 8-item client satisfaction questionnaire. The procedure was well tolerated with good cooperation and no oversedation. Preheating was the most painful, and pain could be alleviated by asking the patient to self-administer a bolus of anesthesia before that phase. The median consumption of propofol was 35 mg (range 0-70 mg) and of alfentanil was 175 microg (range 50-200 microg). There were no intraoperative complications and the overall success rate in treating menorrhagia was 87%. Over 85% of the women did not think that general anesthesia was necessary. They all were highly satisfied and would recommend the procedure to others.
Conclusion:
Patient-controlled sedation is a safe and effective method of alleviating pain and discomfort during thermal balloon ablation and is well accepted by patients.