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

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.