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Paracervical block with combined ketorolac and lidocaine in first trimester surgical abortion

Catherine Cansino, Johns Hopkins University, 2007
See also executive summary and publication in Obstetrics and Gynecology.

Project abstract

In the United States, the majority of first trimester abortions are performed using vacuum aspiration under local anesthesia, commonly with a paracervical block. Most women are given a pre-operative anti-inflammatory agent such as ibuprofen. We propose that pain management can be optimized using a paracervical block of combined lidocaine and ketorolac, eliminating the need for pre-operative analgesia. The dual action of the combined mixture is hypothesized to induce a local anesthetic effect and decrease circulating prostaglandins, thereby resulting in greater pain reduction.

This randomized clinical trial will investigate the difference in perceived pain from first trimester surgical abortions using a paracervical block of combined lidocaine with ketorolac compared to pre-operative ibuprofen and paracervical block with lidocaine. Fifty women who are seeking elective abortions of intrauterine pregnancies no greater than 10 6/7 weeks' gestational age will be recruited. Pain before, during, and after surgical abortion will be measured using a 100-mm visual analog scale (VAS). The primary outcome is the mean difference in pain level from preoperative baseline to time during aspiration comparing the treatment groups. If we see greater pain reduction associated with the paracervical block of lidocaine and ketorolac, adoption of this regimen may improve pain management during first trimester elective abortions.

Specific aim: Our primary objective is to study the analgesic effects of combined lidocaine and ketorolac in a paracervical block compared to preoperative ibuprofen followed by intra-operative paracervical block with lidocaine on women undergoing first trimester surgical abortions. We hypothesize that women undergoing first trimester surgical abortions who receive a paracervical block of combined ketorolac and lidocaine will experience less pain during the procedure based on a visual analog scale (VAS).

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