Our Wing Needle is really taking off! (Pun intended). Here are two different protocols for your consideration. If you use something else and find it works better, please let us know so we can share?
Henrik Skensved’s Protocol, Hillerod, Denmark (reference: Gynecol. Surg (2012) 9:207-212)
- Paracervical block (PCB) using 10 mL of 0.2% ropivacaine at 3,5,7 and 0 o’clock respectively (total of 40 mL). or as per your usual protocol. In addition, 0.5 mL of mepivacaine chloride injected into anterior lip of cervix to avoid pain from placement of tenaculaum. No uterine manipulation or instrumentation whatsoever undertaken for 10 minutes after injection of last dose of ropivacaine.
- For the Fundal Block: place 4mL Citanest (30mg prilocaine/0.54 microgram felypressin per mL) into Myometrium of fundal wall using Wing Needle under direct vision and after aspiration 1mL of local anesthetic was placed medial to each tubal ostia, remaining 2 mL to be injected (1 mL on either side of midline of the fundus)
If you are removing a LNG-IUS (Mirena) prior to ablation, do not remove until after local anesthesia has been delivered, to prevent blood from obscuring hysteroscopic view of uterine cavity
Janesh Gupta’s Protocol, Birmingham Women’s Hospital (reference: European Journal of Obstetrics & Gynecology and Reproductive Biology 170 (2013) 222–224)
- A DCB (Direct Cervical Block) was administered using 6.6 ml 3% mepivacaine hydrochloride (Scandonest, Septodont Ltd.) infiltration deep at the cervical isthmus level at 12, 3, 5, 6, 7, and 9 o’clock positions using a dental needle (Solosupra) (‘Direct Local’)
- The ICOB (Intrauterine Cornual Block) local anaesthetic solution consisted of a total of 2mls mixture of 1 ml 3% mepivacaine (fast acting) and 1 ml of 0.5% bupivacaine (long acting) (AstraZeneca). A hysteroscopic injection of local anaesthetic was given into the myometrium of the uterine fundus just medial to each tubal ostium (ICOB, ‘Focal Local’) with 1.0 ml on each side at a controlled depth of 5 mm under direct vision
- The Thermal Balloon Ablation was started approximately 3 min following the ICOB and performed using our standard protocol