The movement towards the use of local anaesthesia in major vaginal surgery has been successful. This type of desensitizing vaginal wall, uterine margins and pelvic ligaments enables surgery even in those cases which do not allow any other type of anaesthesia.

A polymorbid patient with the total prolapse of an enlarged, ulcerated uterus was planned for surgery designed not only to solve this anatomical status but also to release blocked urethers, thus curing long-lasting purulent nephritis. The operation was prolonged by a cautious approach aimed at eliminating even the smallest pain. After the premedication by morphine (10 mgs), we used Rudocain 4% (320 mgs) diluted with 100 mls of normal saline. The solution was inserted into the vaginal epithelium subfascially and, because we were going to operate in the abdominal cavity, we administered additional doses of local anaesthetics into the cardinal, round and uteroovarian ligaments. The patient was fully conscious and in constant verbal contact throughout. Immediately following the operation the patient confirmed she had been without pain.

Ultimately, the final outcome after three weeks revealed a restored normal vaginal axis, adequate fixation of the vaginal vault and sufficient vaginal patency.

We believe our unique experience of solving advanced, complicated prolapse using local anaesthesia without affecting the patient's comfort proves the possibility of using this type of anaesthesia even in large vaginal operations.

Reid F. Anterior vaginal repair, The Obstetritian and Gynaecologist, 2012;14.137-41
Jomma M. Combined Tension Free Vaginal Tape and Prolapse Repair under Local Anaesthesia in Patients with Symptoms of Both Urinary Incontinence and Prolapse, Gynecol Obstet Invest 2001;51:184-186