Tubal ligation is a permanent method of female sterilization that involves blocking, sealing, or removing the fallopian tubes to prevent future pregnancies. Effective anesthesia management plays a critical role in ensuring patient comfort and optimal surgical conditions during tubal ligation. The choice of anesthetic technique ultimately depends on the surgical approach, the patient’s medical history, and the environment in which the operation is performed.
Tubal ligation can be carried out through laparoscopy, mini-laparotomy, or during a cesarean section. Laparoscopic tubal ligation is typically carried out as an outpatient procedure. This involves inserting a camera and instruments through small abdominal incisions to access the fallopian tubes. Mini-laparotomy, on the other hand, is more often used shortly after childbirth, when the uterus is still enlarged and closer to the abdominal wall. Tubal ligation can also be performed immediately after a cesarean section, taking advantage of the surgical exposure already achieved for delivery. Each surgical method has unique anesthetic considerations, particularly concerning airway management, muscle relaxation, and postoperative pain control 1,2.
For laparoscopic tubal ligation, general anesthesia is often the preferred anesthesia management strategy, as it provides complete unconsciousness, airway protection, and muscle relaxation. These effects are particularly beneficial during this procedure because the abdomen is inflated with carbon dioxide for better visualization. Induction is usually achieved with fast-acting agents such as propofol, and muscle relaxation is maintained with medications like rocuronium. The procedure may be continued with either volatile anesthetic gases or total intravenous anesthesia. While general anesthesia ensures optimal surgical conditions, anesthesiologists must carefully manage issues such as nausea, vomiting, and discomfort in the chest, shoulders, and neck that can occur from residual gas following surgery.
In postpartum or mini-laparotomy procedures, regional anesthesia is a safe and effective alternative. Spinal or epidural blocks provide excellent pain control and avoid the need for airway manipulation. These techniques are particularly advantageous for women who have recently given birth, as they allow them to remain awake and alert while minimizing exposure to systemic drugs. Local anesthetics such as bupivacaine, often combined with a small dose of opioid, provide dense sensory blockade for the duration of the operation. However, because regional anesthesia does not suppress the sensations caused by abdominal distension or high intra-abdominal pressure, it is generally not suitable for the laparoscopic technique 3–8.
Throughout the operation, continuous monitoring of vital signs, oxygen saturation, and carbon dioxide levels is essential. In laparoscopic cases, anesthesiologists must address physiological changes caused by increased intra-abdominal pressure and the absorption of carbon dioxide. Postoperatively, pain control typically involves a combination of acetaminophen and nonsteroidal anti-inflammatory drugs, with opioids reserved for breakthrough discomfort. Shoulder pain, which often results from gas trapped under the diaphragm, can be alleviated by early ambulation and positioning techniques. Nausea and vomiting should be promptly treated to promote recovery and patient comfort 2,9. As always, anesthesia management for tubal ligation must also consider individual medical history and risk factors.
References
1. Tubal Ligation: Procedure, Recovery & Side Effects. Cleveland Clinic https://my.clevelandclinic.org/health/treatments/4933-tubal-ligation.
2. Marino, S., Canela, C. D., Jenkins, S. M. & Nama, N. Tubal Sterilization. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
3. Huffnagle, S. & Huffnagle, H. J. Anesthesia for postpartum tubal ligation. Techniques in Regional Anesthesia and Pain Management 7, 222–228 (2003).
4. Gupta, L., Sinha, S., Pande, M. & Vajifdar, H. Ambulatory Laparoscopic Tubal Ligation: A Comparison of General Anaesthesia with Local Anaesthesia and Sedation. J Anaesthesiol Clin Pharmacol 27, 97–100 (2011).
5. Statement on Anesthesia Support of Postpartum Sterilization. https://www.asahq.org/standards-and-practice-parameters/statement-on-anesthesia-support-of-postpartum-sterilization.
6. Openanesthesia. Postpartum Tubal Ligation. OpenAnesthesia https://www.openanesthesia.org/keywords/postpartum-tubal-ligation/.
7. Anesthesia for tubal ligation | Clinical Gate. https://clinicalgate.com/anesthesia-for-tubal-ligation/.
8. Ansari, J. et al. A retrospective cohort study of the anesthetic management of postpartum tubal ligation. Int J Obstet Anesth 58, 103974 (2024).
9. Prasanna, A. Association of Obstetric Anaesthesiologists guidelines for anaesthetic management of patients undergoing tubal ligation and breast feeding in the perioperative period – some comments. Journal of Obstetric Anaesthesia and Critical Care 1, 100 (2011).