Hysteroscopy - General or Local Anaesthetic?

[RuzGen]

I had a consultant appointment today for thickened womb lining and a possible cyst or polyp.

Was told I need a hysteroscopy which I'm really quite nervous about.

I'm autistic so possibly more anxious than I should be about it but it's really playing on my mind

I've been offered the option of local or general so wanted to get people's thoughts and experiences.

Currently booked in for general so that they are prepped for either scenario and I can decide later on what to go for (if they booked me for local they wouldn't be prepped for general if I changed my mind on the day)

Consultant said it can cause some "mild discomfort" under local but I've learnt from experience that they tend to under estimate pain.

I'm also quite worried that whatever is going on might have got worse as I've waited a year for this consultant appointment

Any advice or thoughts welcome

Thanks all

it sounds like your gynae surgeon doesn't really have a great grasp on the pros and cons of the different anaesthetic techniques. For some women having perineal repair under spinal is much safer (that includes in the immediate postpartum period for most women). The mode of anaesthesia is a decision based on what the anaesthetist thinks is safest/reasonable and agrees with the patient given their medical problems and the operation they're having. A lot of the time a GA is perfectly reasonable, but just every so often (particularly in the post partum context), not having a GA is the better option. The surgeon doesn't get much say in the anaesthetic decision making unless they're doing a procedure under local infiltration.

Or perhaps I have not given every single detail of every single conversation with every single HCP involved? Perhaps my highly experienced consultant had made assessments that took these aspects into account? Perhaps she considered a woman's mental health to be relevant, without considering it to be more important than physical risks inherent in GA?

And I was not in the immediate post partum period. I had the surgery about 10 months pp.

Definitely get a general. My hysteroscopy was incredibly painful, and medics totally understate the level of pain that you can experience, and I only had hysteroscopy with biopsies, no polyp or cyst exiscion. Comparing hysteroscopy pain to period pain is a fucking joke and medics should not be allowed to mislead patients like that. It goes against the concept of informed consent. I'll never be able to trust what a doctor tells me again.
Plus even if you have a local anesthetic, I suspect that the doctor hasn't mentioned that it only helps with cervical pain and as the uterus is served by a different pathway of nerves, and uterine pain will not be affected.

I had the procedure today with sedation and local. I remember being in the theatre the leg stirrups being put up and someone showing me the big screen the feed would be on then next thing I knew I was waking up in recovery.

The most traumatic part was having the canula put in (I'm a wimp with needles)

Got some light cramping and twinges now but I also had my coil changed at the same time so it could also be due to that. Was due for more pain relief a few hours ago but haven't felt the need for it.

For anyone needing to have the procedure there are so many different options (spinal, local, GA, various levels of sedation) so please do push the consultant if they are telling you otherwise.

GA all the way! They will try and persuade you to do a local but as someone who has had multiple hysteroscopies no way

@FNDandme I think sedation is perfectly fine too and if I have it done again that's what I'd go for again. I'm not one for spinals but I think that would also be a perfectly acceptable option. I wanted to avoid GA and the anaesthetists had so many options and were willing to make a plan to suit me.

I don't remember a thing from the procedure. I just woke up in the recovery room.

Our HB doesn’t offer sedation or spinal which I would be open too if they did!

General.
Why raise anxiety levels when you can be relaxed that you will be completely out of it?

@FNDandme it does seem like a bit if a postcode lottery! Awful really. My health board seems to be quite flexible. I didn't really know about the other options until I had a consultation with the anesthetist. Was offered local or GA by the consultant. When I told the anesthetist I had some worries about GA they reeled off all these other options

@RuzGen I just found your thread because I'm in same boat. Going for hysteroscopy and coil change under GA tomorrow. I'm really nervous about the GA. Were you given different options by the anaesthetist on the day? Can I opt for sedation instead of GA tomorrow?

l found it very painful under local anaesthetic , l would advise anyone to have a GA.
Good luck @RuzGen.

@WhereAreWeNow yes on the day I spoke to the anesthetist and said I wanted to avoid GA and have deep sedation instead. He was lovely and came up with a plan for me. In the end he had to knock me out sooner than planned as I was getting distressed by the canula but I still avoided a GA.

I was completely unconscious for the whole thing and woke up feeling great.

Talk to the surgeon and anesthetist on the day and tell them what you are looking for.

Good luck for tomorrow

Thank you @RuzGen . This thread has been really helpful. I'm glad it was OK for you.

I asked anaesthetist about sedation but he said I'd probably still feel pain so I'm going to have GA. Anxiously waiting my turn...

Hope it went well. That's odd because the ones I spoke to said they couldn't guarantee it but most of the time patients tend to be completely unconscious with sedation. It certainly was the case for me and I woke up later on in recovery

It went well thanks @RuzGen . I was pretty sleepy for the rest of the day. Napped in the afternoon and had a good night's sleep too. Felt fine yesterday. A bit sore and crampy but OK. Just taking it easy this weekend.
Very glad to not have been conscious when they were doing the hysteroscopy and biopsy.

Glad it all went well. Hope the soreness goes soon

Errror

I had nothing , was half way through review with consultant when he mentioned it and asked if preferred to arrange and be sedated and I just got it over with there and then - felt a bit sore for a while afterwards on the long drive home but nothing major

Bloody hell! That was excellent then.

sedation doesn’t appear to work for me at all…I was in agony and remember everything.

I tried to have the procedure done with just local but it was so painful they had to abandon it. I went back and had it under general and all went fine.

I was shocked that I couldn’t tolerate the pain as I have had two vaginal births without anything stronger than gas and air.

Experiences are really going to vary, but if you’re nervous, go for the GA.

Good luck 💐