Obstetric Anaesthesia Annual Scientific Meeting 2023

Perioperative Anaesthesia for Cervical Cerclage

Dr C Bryson Consultant Anaesthetist Dr H Cooper ST7 Dr R Morrison ST7

Introduction

Anaesthetic technique for cervical cerclage varies within the UK1. An ongoing RTC is looking at the use of Prilocaine 2% for cervical cerclage compared to Bupivacaine2.

With current NHS bed pressures, reducing unnecessary overnight stays is advantageous. Our unit, a tertiary obstetric centre, introduced Prilocaine 2% for this purpose

Aims

•Remove the need for urinary catheter

•Earlier patient discharge

Methods

•Survey of patients undergoing cervical cerclage between July 2021 and July 2022

•Introduction of a Prilocaine 2% Standard Operating Procedure (SOP)

•Introduction of a revised bladder care pathway for day case/ Prilocaine spinals

•Ongoing survey of patients undergoing cervical cerclage since introduction of our prilocaine 2% SOP

Results: Baseline – 24 Patients

95% spinal; 5% GA

Spinals: 85% L-Bupivacaine 0.5%; 15% Prilocaine 2%

34% received IT opioid

87% had urinary catheters

Mean hospital LOS 23hrs.

All admitted overnight

Results: Post intervention- 11 patients

91% spinal; 9% GA

Spinals: 90% Prilocaine 2%; 10% L-Bupivacaine 0.5%

No IT opioids

20% had urinary catheters

Mean hospital LOS 11hrs

6 (55%) had same day discharge

Discussion

•Cervical cerclage is a well-established day case procedure in other regions

•Our current post-intervention data would suggest that our guidance has increased Prilocaine 2% use

•Along with our new bladder care pathway, this has reduced catheter use and decreased overnight stays

•We continue to promote our new guideline with the aim to establish day case as standard practice for cervical cerclage in our unit

•We plan to continue to monitor this data to ensure good practice with the potential to expand to other procedures.

Obstetric Anaesthesia Annual Scientific Meeting 2023

Improving peri-operative anaesthesia for cervical cerclages - a quality improvement project.

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