[Validity of local anesthesia for female stress urinary incontinence surgery with sub-urethral sling]

To evaluate the feasibility and the comfort of the local anesthesia more or less associated with a light sedation for the sub-urethral vaginal tape in the urinary incontinence surgery.

In a series without selection, 138 patients, benefiting from the isolated sub-urethral vaginal tape surgery (51: Monarc; 18: TVT-O((R)) and 69: TVTSecur, are submitted, after premedication (alpazolam, hydroxyzine), to a pure local anesthesia (ropivacaine-clonidine and adrenalin) for the TVTSecur and associated with a light sedation (midazolam-sufentan) for the TVT-O and Monarc. The anxiety, the peroperative pain and the satisfaction of patients have been evaluated by an analogical visual scale (EVA).

No significant difference is put in obviousness for the preoperative anxiety in three groups, similarly for the peroperative pain classified in three group, EVA: 1-30, 40-60 and 70-100mm with, respectively, for Monarc 54.9, 35.3 and 7.8%, for TVT-O 77.8, 22.2 and 0% and for TVTSecur 47.8, 43.5 and 8.7%. In the postoperative period, analgesics have been prescribed for 92.2 and 94.4% of Monarc and TVT-O and for 7.2% of TVTSecur. More than 92% of patients recommend this type of anesthesia.

Contrarily to the majority of authors that use a deep sedation, the weak dose that we have used allows a perfected vigilance. The interest of ropivacaine associated with clonidine was both to have a vasoconstrictor effect and a prolongation of the analgesic effect with a lesser toxic effect than lidocaine and bupivacaine.

We militate for a return to a minimal invasive anesthesia as that described initially by promoters of the tension-free vaginal tape (TVT), that allows the sub-urethral vaginal tape surgery, under local anesthesia with light sedation, in ambulatory of comfortable manner for patients.