Hysteroscopy is a procedure for examining the uterine cavity using endoscopic equipment. The essence of the method is to insert a special tube into the organ cavity through the cervix. The procedure is not a complex manipulation, but it is painful for the woman. Pain during the examination is associated with dilation of the cervix, which is carried out before insertion of the hysteroscope into the cavity.
Hysteroscopy helps detect intrauterine pathologies
In order to minimize pain during the procedure, the use of anesthesia is indicated. The type of pain relief in each case is determined by the doctor individually. Hysteroscopy is performed on average in 15-20 minutes. However, there are situations when the procedure takes an hour or more. The diagnostic procedure is performed quickly, research with surgical intervention takes longer.
Anesthesia for hysteroscopy
Hysteroscopy belongs to the category of minimally invasive procedures, since during it the doctor does not use a scalpel and does not make incisions in the integumentary tissue to access the uterine cavity. The procedure can be diagnostic or therapeutic in nature. In the first case, a flexible hysteroscope with a small tube diameter is used. This operation is less painful and can be performed without putting the patient into medicated sleep. Therapeutic hysteroscopy is always performed under stronger anesthesia with or without sedation (placement in medicinal sleep).
The use of anesthesia during hysteroscopy of the uterus is strictly regulated. The doctor cannot refuse to use it, since the procedure is quite uncomfortable and lengthy so that patients can endure unpleasant sensations without consequences the entire time the uterine cavity is being examined. At the same time, anesthesia with the most pronounced effect can be used only when performing the most painful manipulations.
Good to know! Cases where hysteroscopy was performed without the use of any type of anesthesia are extremely rare. This can happen if the patient is intolerant to all drugs.
The choice of drugs and method of pain relief during hysteroscopy is the prerogative of the doctor. If the patient has contraindications, the specialist will find an alternative option.
Rehabilitation after hysteroresectoscopy
It takes about a month for the uterus to recover. This fact is signified by the patient’s menstruation. A prolonged absence of menstruation after hysteroresectoscopy is a reason to consult a doctor. The cause of concern is the delay period of more than 50 days. The cycle recovery occurs within 4-6 months.
Immediately after the operation, slight bloody or pink mucous discharge is observed, which eventually turns brown and disappears after about a week.
During this period, the woman is prescribed antibiotics and regular examinations. Based on the histology results, the need for hormone treatment is determined. We talked about recommendations and prohibitions for the patient in the previous section.
If a major surgical operation was performed, the woman remains in the hospital for a week or longer, depending on the condition. After outpatient removal, the patient goes home 3-4 hours later, when she wakes up and recovers from anesthesia.
What kind of anesthesia is used for hysteroscopy?
The choice of individual types of anesthesia for hysteroscopy is made based on the purpose of the operation. For example, a diagnostic procedure is not accompanied by extensive trauma to the inner lining of the uterus, so local anesthesia can be used. When removing a uterine polyp or dissecting the intrauterine septum, more reliable and deep anesthesia is required, therefore it is recommended to use general or epidural anesthesia for this procedure.
Local anesthesia
In gynecology and in clinical practice in general, local anesthesia refers to local anesthesia, which is carried out by injecting an anesthetic solution into the points where the nerve bundles responsible for the sensation of pain in a certain area are located. In the uterus, such bundles are located in the cervix (paracervical region). This method works as a regular “freezing”: the patient is conscious during hysteroscopy and feels the touches and manipulations performed by the doctor. At the same time, the sensation of pain is temporarily “switched off.”
Good to know! The local anesthetic does not act for long, about 1-2 hours, so it is used for diagnostic hysteroscopy.
Lidocaine and Ultracaine are used for local anesthesia. If the patient is very worried, together with the anesthetic, the doctor can use a sedative - a sedative that balances the emotional state without causing drowsiness and confusion. The most commonly used drugs are Droperidol, Pentran or Fentanyl. In situations where local anesthesia is used, supervision by an anesthesiologist is not required.
General anesthesia
During hysteroscopy, general anesthesia is used if surgical intervention on the uterus is necessary:
- removal of the endometrium, foci of hyperplasia, fibroids and cysts;
- removal of ingrown spirals;
- removal from the uterine cavity of a frozen fetus or the remains of an aborted fertilized egg.
It can also be used for hysteroscopy with curettage. Such manipulations take a lot of time and are quite painful, and the procedure itself takes place in a hospital setting.
Important! When using general anesthesia, hysteroscopy is performed with the participation of an anesthesiologist.
Drugs can be administered either intravenously (Propofol or Midazolam) or via a facial or laryngeal mask (Isoflurane or Sevoflurane). In some cases, the anesthesiologist uses combined anesthesia, when the patient is given a small dose of medication intravenously and a mask is used during the operation.
When using this type of anesthesia, the patient is in a state of drug-induced sleep. She does not hear or feel what is happening in the operating room during hysteroscopy. When the effect of the medication weakens, dizziness, headache, nausea, and drowsiness may occur, so the patient requires medical supervision for several hours.
Regional anesthesia
Regional or spinal anesthesia is considered the safest and most effective method of pain relief for lower body surgery. It is also known as an epidural. The main feature of the method is that the drug is injected into the tissue near the spine. In this way, all nerves located below the injection site are blocked: the lower abdomen, buttocks and legs completely lose sensitivity, while the patient is conscious and can communicate with the doctor.
Epidural anesthesia is performed only by an anesthesiologist. In general, this method is much more effective than other types, has fewer side effects, but requires the doctor to have special skills.
Indications and contraindications for
Using an office procedure, the causes of various gynecological symptoms are determined. The study is indicated for problems such as:
- painful menstruation;
- irregular bleeding;
- heavy bleeding with the release of clots;
- repeated miscarriages;
- late pregnancy loss;
- infertility;
- abnormal structure of the uterus.
Diagnostic hysteroscopy is prescribed if adhesions, internal endometriosis and the presence of small tumors are suspected. Diagnosis using this method allows you to accurately determine what type of endometrial pathology is present in the uterus (ultrasound gives only a general picture). The method is also used before in vitro fertilization after an initial consultation with an obstetrician-gynecologist.
Various diseases related to the field of gynecology may serve as contraindications to the implementation of the method. First of all, these are inflammatory and infectious processes in the uterine cavity and appendages in the acute stage, pregnancy and disorders of the vaginal microflora (vaginosis). The procedure is not performed for systemic viral and bacterial infections, as well as in the presence of uterine bleeding.
Important! If there are contraindications, the doctor prescribes treatment for these conditions. After tests confirm that the disease has been eliminated, hysteroscopy may be performed.
Which anesthesia is better
It is definitely impossible to single out the best method of pain relief. Each of them has advantages and disadvantages. Certain types of hysteroscopy may be ideal in one case, but in others they will be ineffective or dangerous to the patient’s health. Therefore, the choice under which anesthesia to perform hysteroscopy is made after carefully weighing all the pros and cons.
Local anesthesia is used if the expected duration of the intervention does not exceed 15 minutes, and when tumor removal is not planned during the procedure. This is the most affordable option, which has a minimum of side effects and does not require recovery. However, it has disadvantages such as maintaining sensitivity. For example, when a biopsy is taken, the patient may feel discomfort.
General anesthesia does not have the disadvantages of local anesthesia, but it is much more expensive. After hysteroscopy using it, the patient feels unpleasant symptoms for several hours: weakness, nausea, dizziness. The recovery period after using this method can be up to 24 hours (depending on what type of anesthetic was used - injection or mask). It is not advisable to use it for short-term diagnostic interventions.
Spinal (epidural, regional) anesthesia for hysteroscopy is an ideal option. It is free of side effects and completely eliminates discomfort during and after the procedure. However, it may not be used in all clinics, since not all anesthesiologists have the necessary skills. The main disadvantage of this type is the high cost.
How to prepare for research
To undergo hysteroscopy, the patient must prepare as follows:
- Avoid using douches and do not use vaginal suppositories or tampons.
- Avoid sexual intercourse 2 days before the study.
- Take food no later than 19 pm, and water no later than 24 hours.
- Mandatory evening enema with clean water.
- Emptying the bladder before the study.
- Taking a shower, treating the pubis and perineum (shaving).
- Take antibiotics 2 hours before the test (to prevent complications).
- Taking mild sedatives for nervous excitement or anxiety (valerian, peony, motherwort).
- Take hygiene products with you (cotton socks and shirt, pads, towel, disposable sheet).
Is it possible to do hysteroscopy without anesthesia?
The inability to use the combined use of hysteroscopy and anesthesia is extremely rare. The only situation when a doctor can insist on refusing anesthesia is when performing a simple survey hysteroscopy with a flexible device. The diameter of the tube of such a device allows you to examine the uterine cavity without expanding the cervical canal.
Good to know! In most cases, anesthesia is used to relieve discomfort during cervical dilatation, so drugs are not used unless necessary.
In extremely rare cases, nerve blocking is not used due to the high risk of complications and side effects: if the patient has serious diseases that preclude the use of sedatives and anesthetics, or if she is allergic to drugs.
Recovery period
Typically, examination with a hysteroscope has no consequences for the patient. Such patients do not need any medical supervision.
Complications and bleeding after hysteroscopy are extremely rare.
But still, after this procedure, the doctor usually gives the woman the following recommendations:
- temperature measurement;
- washing the genitals twice a day;
- exclusion of any stress and sex for a period of 2 weeks;
- taking antibacterial drugs to prevent the development of a bacterial infection;
- assessment of discharge after manipulation: short-term discharge of moderate volume is considered normal;
- to relieve possible pain, analgesics (Analgin, Ibuprom, Nimesil, Baralgetas) are used for 2-3 days;
- it is advisable to use birth control for 1-2 months after the procedure;
- It is not recommended to use vaginal tablets, suppositories or tampons for 2 weeks;
- For several days after the study, visiting a bathhouse, sauna, or swimming pool is undesirable, and bathing in a bathtub is better replaced with a shower.
All such precautions are necessary to prevent complications. Usually, by 3-5 days after the manipulation, the woman returns to her usual lifestyle.
Is anesthesia dangerous during the procedure?
The danger of anesthesia is often greatly exaggerated. Modern medicine has modern drugs that make it possible to carry out interventions using sedatives and anesthetics without any risk to the patient’s health. Most drugs are approved for use for concomitant diseases that were previously contraindications to the use of anesthesia.
Most complications that appear after the use of sedation and anesthetics are in one way or another associated with violation of recommendations for preparation for the procedure or during the rehabilitation period. In order for the operation to be successful and to avoid complications as a result, it is enough for the patient to strictly follow the instructions given by the anesthesiologist and gynecologist.
