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Paracervical block for pain control in first-trimester surgical abortion: a randomized controlled trial.
Obstet Gynecol. 2012 May; 119(5):1030-7.OG

Abstract

OBJECTIVE

Despite lack of efficacy data, the majority of first-trimester surgical abortions are performed with a paracervical block. Women may be unnecessarily exposed to a painful injection and potentially noxious medication. Our objective was to estimate the effect of a paracervical block and the effect of gestational age on patient pain perception.

METHODS

This was a randomized, single-blind trial of patients undergoing abortion receiving paracervical block or sham stratified by gestational age (early: less than 8 weeks of gestation, n=60; late: 8-10 6/7 weeks of gestation, n=60). Premedicated with ibuprofen and lorazepam, all participants received 2 mL 1% buffered lidocaine injected at the tenaculum site followed by a slow, deep injection of 18 mL at four sites (block) or no injection (sham) with a 3-minute wait. The primary outcome was dilation pain (100-mm visual analog scale). Secondary outcomes included pain at additional time points, satisfaction, need for more analgesics, and adverse events.

RESULTS

Full enrollment occurred (n=120). We used intent-to-treat analysis. Demographics did not differ between groups. Paracervical block administration was painful (mean 55 mm compared with sham 30 mm, P<.001) but decreased dilation pain (42 mm compared with 79 mm, P<.001) and aspiration pain (63mm compared with 89 mm, P<.001). These results were consistent for both gestational age strata; however, paracervical block benefit was greater at an earlier gestation. Satisfaction scores with pain control and the procedure were significantly higher in the block group.

CONCLUSION

Although paracervical block is painful, it reduces first-trimester abortion pain regardless of gestational age, but the benefit on dilation pain was greater at earlier gestations.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094366.

LEVEL OF EVIDENCE

I.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA. rerenner@bluewin.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22525915

Citation

Renner, Regina-Maria, et al. "Paracervical Block for Pain Control in First-trimester Surgical Abortion: a Randomized Controlled Trial." Obstetrics and Gynecology, vol. 119, no. 5, 2012, pp. 1030-7.
Renner RM, Nichols MD, Jensen JT, et al. Paracervical block for pain control in first-trimester surgical abortion: a randomized controlled trial. Obstet Gynecol. 2012;119(5):1030-7.
Renner, R. M., Nichols, M. D., Jensen, J. T., Li, H., & Edelman, A. B. (2012). Paracervical block for pain control in first-trimester surgical abortion: a randomized controlled trial. Obstetrics and Gynecology, 119(5), 1030-7. https://doi.org/10.1097/AOG.0b013e318250b13e
Renner RM, et al. Paracervical Block for Pain Control in First-trimester Surgical Abortion: a Randomized Controlled Trial. Obstet Gynecol. 2012;119(5):1030-7. PubMed PMID: 22525915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Paracervical block for pain control in first-trimester surgical abortion: a randomized controlled trial. AU - Renner,Regina-Maria, AU - Nichols,Mark D, AU - Jensen,Jeffrey T, AU - Li,Hong, AU - Edelman,Alison B, PY - 2012/4/25/entrez PY - 2012/4/25/pubmed PY - 2012/7/28/medline SP - 1030 EP - 7 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 119 IS - 5 N2 - OBJECTIVE: Despite lack of efficacy data, the majority of first-trimester surgical abortions are performed with a paracervical block. Women may be unnecessarily exposed to a painful injection and potentially noxious medication. Our objective was to estimate the effect of a paracervical block and the effect of gestational age on patient pain perception. METHODS: This was a randomized, single-blind trial of patients undergoing abortion receiving paracervical block or sham stratified by gestational age (early: less than 8 weeks of gestation, n=60; late: 8-10 6/7 weeks of gestation, n=60). Premedicated with ibuprofen and lorazepam, all participants received 2 mL 1% buffered lidocaine injected at the tenaculum site followed by a slow, deep injection of 18 mL at four sites (block) or no injection (sham) with a 3-minute wait. The primary outcome was dilation pain (100-mm visual analog scale). Secondary outcomes included pain at additional time points, satisfaction, need for more analgesics, and adverse events. RESULTS: Full enrollment occurred (n=120). We used intent-to-treat analysis. Demographics did not differ between groups. Paracervical block administration was painful (mean 55 mm compared with sham 30 mm, P<.001) but decreased dilation pain (42 mm compared with 79 mm, P<.001) and aspiration pain (63mm compared with 89 mm, P<.001). These results were consistent for both gestational age strata; however, paracervical block benefit was greater at an earlier gestation. Satisfaction scores with pain control and the procedure were significantly higher in the block group. CONCLUSION: Although paracervical block is painful, it reduces first-trimester abortion pain regardless of gestational age, but the benefit on dilation pain was greater at earlier gestations. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094366. LEVEL OF EVIDENCE: I. SN - 1873-233X UR - https://www.unboundmedicine.com/medline/citation/22525915/Paracervical_block_for_pain_control_in_first_trimester_surgical_abortion:_a_randomized_controlled_trial_ L2 - https://doi.org/10.1097/AOG.0b013e318250b13e DB - PRIME DP - Unbound Medicine ER -