Position: Supine, Trendelenburg
Time: 2-4 hours (long)
Blood Loss: High (200 – 500 ml)

Maintenance Paralytic: Yes

Blocks: Ilioinguinal/Iliohyprogastric, TAP – mid-axillary

Have atropine or glycopyrrolate (Robinul) available. These drugs are to counteract bradycardia associated with the trendelenburg position and/or vagal stimulation commonly seen with uterine procedures.

Like most abdominal procedures, heat loss can be significant through the open incision. Apply an upper body convection blanket as soon as possible.

Trendelenburg position implies increased CVP and PIP. Increased chances of gastric regurgitation.

Surgeon may inject epinephrine or vasopressin to decrease local bleeding (monitor for brady/tachydysrythmias).

PONV common. Use a multimodal approach where possible.

Postoperative Pain – bilateral mid-axillary TAP and/or Ilioinguinal-Iliohypogastric blocks are very effective for postoperative pain. PCA pumps are also sometimes utilized. Use adjuncts such as NSAIDS and/or acetaminophen where possible.

Foley catheter – the procedure will likely be more than 2 hours

Sometimes an enlarged uterus will obstruct ureters – so be aware of kidney function.

High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.

Long procedure (general considerations): Procedures anticipated to last longer than 2 hours generally require a urinary catheter. Also consider checking lines and positioning regularly as the risks of infiltration and nerve damage are increased with procedure time. Consider an IV fluid warmer and a forced air warmer to keep the patient euthermic.

This is the removal of the uterus through an incision made in the abdomen.