Tubal ligation
Anesthesia type

GA vs. neuraxial

Airway

ETT vs. LMA

Lines and access

20G 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

Operating room setup

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, though only 68% of catheters were functionanl 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

Induction and airway management

Positioning

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

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain 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

References