A retrospective review of the type of anaesthesia used for LLETZ: proposal for a categorisation audit tool

Large loop excision of the transformation zone (LLETZ) is the most common form of treatment for cervical pre-cancer. The majority of procedures should be performed under local anaesthesia (LA) in an outpatient setting.

To review the reasons behind choice of general anaesthesia (GA) for LLETZ and to devise a categorisation tool for audit purposes.

Review of the type of anaesthesia and histopathological findings for all cases of LLETZ performed at Wexford General Hospital between January 2010 and June 2013 inclusive.

Of the 970 cases reviewed, 829 (85.5 %) were performed under LA and 141 (14.5 %) under GA. In five of the 141 GA cases the indication could not be established. The remaining 136 cases could be classified into three categories based on their indications for choosing GA: Category I: 46 cases (33.8 %) where there was associated pathology requiring treatment under GA. Category II: 56 cases (41.2 %) where the colposcopist anticipated difficulty with the procedure and decided on GA. Category III: 34 remaining cases (25 %), where GA was requested by the patient. During the study period the GA rate decreased significantly from 19.4 to 10 % due to a decrease in category II numbers. Higher rates of complete excision of pre-cancer were not found in the GA group.

The use of GA for LLETZ rarely confers benefits in terms of diagnostic or therapeutic quality indicators. The categorisation we propose is a simple audit tool that could be adopted by all colposcopy units to reduce the rate of GA.