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Refining paracervical block techniques for pain control in first trimester surgical abortion

Paula Bednarek, Oregon Health and Science University, 2011

Project abstract

The majority of surgical abortions in the United States are performed under local anesthesia with a paracervical block (PCB), but women still report experiencing significant amounts of procedure-related pain. Although considered the cornerstone of outpatient anesthesia for abortion care, the PCB is not supported by robust evidence.

Only recently, our research group established the benefit of a specific PCB technique: 20mL 1% buffered lidocaine (2mL at tenaculum site, 18mL paracervical at 4-sites), with a 3 minute wait prior to cervical dilation (PCB 20/4/3). This is the only PCB study to date which has evaluated patients receiving no IV medications and utilizing a sham-PCB control group (2mL injection of 1% buffered lidocaine at the tenaculum site only).

As the administration of a PCB is painful and the 3-minute wait adds procedural time, further refinement of this technique is warranted. The ideal PCB would be effective with fewer injection sites and no delay prior to dilation.

We propose a randomized controlled non-inferiority trial of women undergoing first trimester surgical abortion to compare pain with dilation after receiving a PCB 20/4/3 versus a PCB with fewer injection sites and with no delay. The primary outcome is pain with cervical dilation. Secondary outcomes include pain at additional time points before, during, and after the procedure; satisfaction; side effects; and need for additional intraoperative and postoperative pain medication.

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