Tubal ligation

Tubal ligation

Anesthesia type	Neuraxial or general
Airway	ETT/LMA if general
Lines and access	PIV
Monitors	Standard
Primary anesthetic considerations
Preoperative	Full stomach precautions in postpartum patients
Intraoperative
Postoperative
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A tubal ligation is a surgical procedure for female sterilization that involves severing and tying the fallopian tubes. Most are done laparoscopically, but at times it is performed during a C-section while the uterus is externalized. Some are done 8 hours post-partum. Recently, a transcervical method has emerged which can be performed in the doctor's office.

This procedure is 99% effective in the first year, but fallopian tubes can rarely reform or reconnect. Of those failures, 15-20% of pregnancies are likely to be ectopic.

Preoperative management

Patient evaluation

System	Considerations
Airway	Airway challenges of pregnancy occur during postpartum procedures
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal	Postpartum patients should be considered full stomach Patients should be NPO through labor and postpartum until time of surgery
Hematologic
Renal
Endocrine
Other

Labs and studies

• None

Patient preparation and premedication

• Timing can be intrapartum (during C-section) or at least 8 hours postpartum

Regional and neuraxial techniques

• Epidural from delivery can be utilized
  • 93% of epidural catheters were functional for postpartum tubal ligation within 1-4 hours of delivery
  • Only 68% of catheters were functional during hours 5-8 after delivery.
• T4 level required for procedure
• Spinal anesthesia can also be utilized

Intraoperative management

Monitoring and access

• Standard monitors
• 20G PIV

Positioning

• Supine for all laparotomy/laparoscopic procedures
• For transcervical procedures, lithotomy position utilized

Postoperative management

Potential complications

• Bleeding
• Infection
• Damage to bowel, bladder, major vessels
• Prolonged abdominal or pelvic pain

Procedure variants

	Laparoscopic	Mini-laparotomy	Post-Partum	Transcervical
Anesthetic	GA/ETT or spinal (T4 sensory block)	GA/ETT or spinal (T4 sensory block)	Epidural, spinal, or GA	GA/LMA
Position	Supine	Supine		Lithotomy, may need slight Trendelenburg
Surgical time	15-45 mins	15-45 mins		In office, usually 30 mins
EBL	Minimal	Minimal	Minimal	Minimal
Postoperative disposition				Home
Pain management
Potential complications