Anesthesia for postpartum tubal ligation

Postpartum tubal ligation is an elective procedure that can be performed safely shortly after delivery, provided the patient’s labor was uncomplicated, she is hemodynamically stable, and she understands the risks and alternatives to the surgery and anesthesia. Epidural, spinal, general, or local anesthesia with sedation has been used for postpartum tubal ligation. The most convenient anesthetic is reactivation or extension of an already existing epidural, and the success is increased when postpartum tubal ligation is performed within 4 to 8 hours of delivery.

Most of the physiologic changes that occur during pregnancy are still present in the postpartum period. Postpartum patients have delayed gastric emptying of solid foods and should be given some form of gastric acid prophylaxis before inducing anesthesia.

Postpartum tubal ligation (PPTL) produces moderate to severe pain of short duration, so one must provide some form of postoperative pain relief. Although there is controversy regarding the use of ketorolac, a nonsteroidal anti-inflammatory medication, in breast-feeding mothers, the American Academy of Pediatrics considers it safe. Other oral opioid and nonopioid pain medications are also effective in treating postoperative pain.