Introduction Transvaginal cervical cerclage (TVCC) is a common operation in pregnancy requiring an anaesthetic. Regional anaesthesia (RA) aims for T10 sensory blockade.¹ No data exists to guide the type of anaesthesia or intrathecal dose of local anaesthesia (IDLA) that should be employed for TVCC.²

Aim To determine the type of anaesthesia given for TVCC and the IDLA used for RA.

Method Ethical approval waived. Case notes of women having TVCC during pregnancy (January 2005–December 2012) were identified using the Obstetric Anaesthesia database and cross-referenced with the Preterm Birth clinic database. Analysis was conducted using Microsoft Excel.

Results In 165 women both general anaesthesia (n = 26, 16%) and RA (n = 139, 84%) were given at a mean gestational age of 16.6 weeks (range 9–23.6weeks). Of the RA group 95.7% were spinals, of which 5 women required a second anaesthetic procedure. There were no major anaesthetic complications and in all women TVCC was achieved successfully. Of the women receiving intrathecal anaesthesia 67.4% (93/138) documented IDLA. Hyperbaric bupivacaine 0.5% was used in all cases (mean dose 10.9mg, 6.5–15 mg). Both sensory block and IDLA was documented in 58% of intrathecal anaesthesia cases (54/93). The sensory block ranged from height T2–T12 and was not associated with IDLA, gestational age or body mass index at booking. Opiates were used in 73/93 women (78.5%), the most common being fentanyl (94%) with a mean dose of 20 mcg.

Conclusion In this series TVCC was performed safely under both general and RA. There is a wide variation in IDLA and sensory block.

References

1. Chestnut P, Wong T. (2009) Chestnut’s Obstetric Anesthesia: Principles and Practice, 4^th Edition, Philadelphia: Elsevier

2. Cervical Cerclage, Green-top Guideline No 60, Royal College of Obstetricians and Gynaecologists, May 2011