Syringe or mask? Loop electrosurgical excision procedure under local or general anesthesia: a randomized trial

Area of Science:

• Gynecology
• Surgical Procedures
• Anesthesia

Background:

• Loop electrosurgical excision procedure (LEEP) is performed under local or general anesthesia globally.
• No prior randomized trials have directly compared these anesthesia methods for LEEP.

Purpose of the Study:

• To compare patient satisfaction and procedure-related outcomes of LEEP under local versus general anesthesia.
• Key outcomes included margin involvement, complications, pain, and blood loss.

Main Methods:

• A randomized trial involving 208 women undergoing LEEP.
• Procedures were performed under local anesthesia (bupivacaine) or general anesthesia (fentanyl, propofol, sevoflurane).
• Patient satisfaction was assessed using a Likert scale; secondary outcomes included margin status, complications, blood loss, and surgeon preference.

Main Results:

• Patient satisfaction did not significantly differ between local and general anesthesia groups immediately post-surgery or at 14 days.
• Local anesthesia was associated with smaller cone volumes and less intraoperative blood loss (per-protocol analysis).
• Surgeon preference favored general anesthesia, though other secondary outcomes were comparable.

Conclusions:

• Loop electrosurgical excision procedure under local anesthesia is well-tolerated and offers patient-reported and procedural benefits compared to general anesthesia.
• Findings support local anesthesia as a viable and potentially advantageous option for LEEP.