Validity of local anesthesia for female stress urinary incontinence surgery with sub-urethral sting

Objective. -To evaluate the feasibility and the comfort of the local anesthesia more or less associated with a light sedation for the sub-urethra[ vaginal tape in the urinary incontinence surgery. Material and methods. - In a series without selection, 138 patients, benefiting from the isolated sub-urethral vaginal. tape surgery (51: Monarc (R); 18: TVT-(R) and 69: TVT Secur (R)), are submitted, after premedication (alpazolam, hydroxyzine), to a pure local anesthesia (ropivacaine-clonidine and adrenalin) for the TVTSecur (R) and associated with a light sedation (midazolam-sufentan) for the TVT-(R) and Monarc (R). The anxiety, the peroperative pain and the satisfaction of patients have been evaluated by an analogical visual scale (EVA). Results. - 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 70-100 mm with, respectively, for Monarc (R) 54.9, 35.3 and 7.8%, for TVT-(R) 77.8, 22.2 and 0% and for TVTSecur (R) 47.8, 43.5 and 8.7%. In the postoperative period, analgesics have been prescribed for 92.2 and 94.4% of Monarc (R) and TVT-(R) and for 7.2% of TVTSecur (R). More than 92% of patients recommend this type of anesthesia. Discussion. - 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. Conclusion. - 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. (c) 2007 Elsevier Masson SAS. Tous droits reserves.