General Versus Local Anesthesia in Loop Electrosurgical Excision Procedures: A Systematic Review and Meta-Analysis.

IF 2.4 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Journal of Lower Genital Tract Disease Pub Date : 2025-07-16 DOI:10.1097/LGT.0000000000000906

Rafaela Germano Toledo, Yasmin Dias, Rafael R H Martin, Michele R Hacker, Andrew Wiechert, Huma Farid

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引用次数: 0

Abstract

Objective: Loop electrosurgical excision (LEEP) is the standard of care for high-grade cervical intraepithelial neoplasia. The primary aim of this study was to compare patient-reported outcomes among patients who received local anesthesia (LA) during LEEP with those who received GA.

Materials and methods: PubMed, Embase, and Cochrane databases were searched for studies comparing GA with LA in LEEP. Primary outcomes were postprocedure pain and satisfaction, including the likelihood of choosing the same anesthesia method again. Statistical analysis used Review Manager 5.4, heterogeneity was assessed with I2, and a random-effects model was applied.

Results: Six studies (2169 patients; 1,536 LA, 633 GA) met inclusion criteria. Postprocedure pain was slightly lower with GA than LA (standardized mean difference: -0.49, 95% CI = -1.88, 0.89), but this was not statistically significant. Satisfaction was higher for GA (odds ratio: 1.62; 95% CI = 0.94, 2.79), though not significantly. GA patients had larger cone volumes (mean difference: 0.46 cm3; 95% CI = 0.29, 0.62), and deeper excisions, though depth was not statistically significant (mean difference: 0.75 mm; 95% CI = -0.23, 1.74).

Conclusions: While GA was associated with minimally lower pain and greater satisfaction, these differences were not statistically or clinically meaningful. GA was also linked to larger cone volumes, potentially increasing risks for future pregnancies. Given the higher risks and costs of GA, LA may be preferable for LEEP.

查看原文本刊更多论文

环行电切术中全身麻醉与局部麻醉：系统回顾和荟萃分析。

目的：环形电切术（LEEP）是高级别宫颈上皮内瘤变的标准治疗方法。本研究的主要目的是比较在LEEP期间接受局部麻醉（LA）的患者与接受GA的患者之间的患者报告的结果。材料和方法：检索PubMed， Embase和Cochrane数据库，比较GA和LA在LEEP中的研究。主要结局是术后疼痛和满意度，包括再次选择相同麻醉方法的可能性。统计分析采用Review Manager 5.4，异质性评价采用I2，采用随机效应模型。结果：6项研究(2169例患者；1,536 LA, 633 GA)符合纳入标准。GA组术后疼痛略低于LA组（标准化平均差异：-0.49,95% CI = -1.88, 0.89），但无统计学意义。GA的满意度更高(优势比：1.62；95% CI = 0.94, 2.79)，但差异不显著。GA患者锥体体积较大(平均差异：0.46 cm3；95% CI = 0.29, 0.62)和更深的切除，尽管深度无统计学意义(平均差异：0.75 mm；95% ci = -0.23, 1.74)。结论：虽然GA与最低限度的疼痛和更高的满意度相关，但这些差异没有统计学意义或临床意义。GA还与更大的锥体体积有关，这可能会增加未来怀孕的风险。考虑到GA较高的风险和成本，LA可能优于LEEP。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Lower Genital Tract Disease OBSTETRICS & GYNECOLOGY-

CiteScore

6.80

自引率

8.10%

发文量

158

审稿时长

6-12 weeks

期刊介绍： The Journal of Lower Genital Tract Disease is the source for the latest science about benign and malignant conditions of the cervix, vagina, vulva, and anus. The Journal publishes peer-reviewed original research original research that addresses prevalence, causes, mechanisms, diagnosis, course, treatment, and prevention of lower genital tract disease. We publish clinical guidelines, position papers, cost-effectiveness analyses, narrative reviews, and systematic reviews, including meta-analyses. We also publish papers about research and reporting methods, opinions about controversial medical issues. Of particular note, we encourage material in any of the above mentioned categories that is related to improving patient care, avoiding medical errors, and comparative effectiveness research. We encourage publication of evidence-based guidelines, diagnostic and therapeutic algorithms, and decision aids. Original research and reviews may be sub-classified according to topic: cervix and HPV, vulva and vagina, perianal and anal, basic science, and education and learning. The scope and readership of the journal extend to several disciplines: gynecology, internal medicine, family practice, dermatology, physical therapy, pathology, sociology, psychology, anthropology, sex therapy, and pharmacology. The Journal of Lower Genital Tract Disease highlights needs for future research, and enhances health care. The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology, the International Society for the Study of Vulvovaginal Disease, and the International Federation of Cervical Pathology and Colposcopy, and sponsored by the Australian Society for Colposcopy and Cervical Pathology and the Society of Canadian Colposcopists.