Expenditure, Side Effect and Satisfaction of Total Intravenous Anesthesia, Spinal Anesthesia and Epidural Anesthesia for Postpartum Tubal Ligation in Phichit Hospital

Abstract

     Anesthetic techniques for postpartum tubal ligation range from local anesthesia to neuraxial or general anesthesia. In current cost-conscious environment, it is important to examine the impact of anesthetic techniques. Thus, this study had the objective to compare anesthetic-related institute expenditure between three anesthetic techniques for postpartum tubal ligation (TIVA: total intravenous anesthesia, SA: spinal anesthesia and EA: epidural anesthesia), patient satisfaction and incidence of postoperative side effects. Prospective randomized controlled trial (RCT) was conducted. Ninety consenting patients undergoing postpartum tubal ligation were randomly assigned to one of three anesthetic technique groups: control group receiving TIVA; study group receiving SA or EA. The mean total perioperative costs were significantly decreased in group EA (฿152.6±28.1 compared with ฿272.8±107.3 and ฿281.5±28.1 in groups TIVA and SA, respectively) because both intraoperative and recovery costs were lowest (P < 0.05). Although the recovery cost of group SA did not differ from group EA, but the intraoperative cost were significantly increase in group SA because EA used lower price of  xylocaine and reused epidural needle, but SA used higher price of bupivacaine and dispossible spinal needle. There was no significant difference among the three groups with the postoperative side effects; hypotension, nausea, urinary retention and headache. However, the need for pain medication was more in groups TIVA (23.3% and 0% for group SA and EA; P < 0.05). No patient was dissatisfied with the anesthetic techniques  they received. The conclusion of this study, epidural anesthesia had the money expenditure lowest compared with spinal or total intravenous anesthesia for postpartum tubal ligation in Phichit hospital. Low incidence of severe side effects was detected. Analgesia was the great outcome, the patients had excellent satisfaction and the obstrictian could easiler approach for operation. Of course, the anesthesiologist could applied this technique for practical optimum.

Keyword:  expenditure, side effect, satisfaction total intravenous anesthesia, spinal anesthesia, epidural anesthesia, postpartum tubal ligation