Anesthesia for postpartum tubal ligation

Suzanne Huffnagle, DOa, , , H.Jane Huffnagle, DOa

a Department of Anesthesiology, Jefferson Medical College, homas Jefferson
!ni"ersity, #hiladelphia, #A, !SA
A"ailable online $$ January $%%&.
http'((d).doi.org(*%.*%+,(S*%-&.$%-/0%,1%%%,2.,, Ho3 to Cite or 4in5 !sing DO6
#ermissions 7 8eprints
Abstract
#ostpartum tubal ligation is an electi"e procedure that can be performed safely shortly
after deli"ery, pro"ided the patient9s labor 3as uncomplicated, she is hemodynamically
stable, and she understands the ris5s and alternati"es to the surgery and anesthesia.
:pidural, spinal, general, or local anesthesia 3ith sedation has been used for
postpartum tubal ligation. he most con"enient anesthetic is reacti"ation or e)tension of
an already e)isting epidural, and the success is increased 3hen postpartum tubal
ligation is performed 3ithin & to - hours of deli"ery.
Most of the physiologic changes that occur during pregnancy are still present in the
postpartum period. #ostpartum patients ha"e delayed gastric emptying of solid foods
and should be gi"en some form of gastric acid prophyla)is before inducing anesthesia.
#ostpartum tubal ligation 0##41 produces moderate to se"ere pain of short duration, so
one must pro"ide some form of postoperati"e pain relief. Although there is contro"ersy
regarding the use of 5etorolac, a nonsteroidal anti.inflammatory medication, in breast.
feeding mothers, the American Academy of #ediatrics considers it safe. Other oral opioid
and nonopioid pain medications are also effecti"e in treating postoperati"e pain.
;igures and tables from this article'
;ig *. Ma)imum bloc5 height occurs *+ minutes after hyperbaric intrathecal bupi"acaine.
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;ig $. 4oss of sensation to pinpric5 "ersus height at $% minutes after ?+ mg of intrathecal
hyperbaric lidocaine, sho3ing only a slight correlation of height and le"el of bloc5.
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;ig ,. Successful epidural acti"ation for ##4 is greatest 3ithin & hours of deli"ery.
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;ig &. Decreased plasma cholinesterase le"els during pregnancy and ? days
postpartum. 8eprinted 3ith permission.&+
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;ig +. =arious techni@ues for tubal sterilization, including the #omeroy techni@ue.
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AA4: *. Delayed :mptying of Solid ;oods #ostpartum
=alues are mean B SDC AM6 D body mass inde).8eprinted 3ith permission.$%
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AA4: $. Eastric Contents 3ith pH F $.+ and =olume G $+ m4
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AA4: ,. Spinal Aupi"acaine and Duration of Motor Aloc5
#AC! D #ost.Anesthesia Care !nitC D(C D discharge.8eprinted 3ith permission.*-
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AA4: &. Summary of Anesthetic echni@ues for ##4
MSO& D morphine sulfateC 6= D intra"enousC #O D by mouthC SH D subcutaneous.
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Address reprint re@uests to Suzanne Huffnagle, D.O., Department of Anesthesiology,
Jefferson Medical College, homas Jefferson !ni"ersity, +$& Main building, *** South
>alnut Street, #hiladelphia, #A, !SA
Copyright I $%%, :lse"ier 6nc. All rights reser"ed.