Main Article Content
Objectives: To evaluate efficacy of intravenous sedation, paracervical block (PCB) and PCB plus lidocaine spray for pain relief during uterine curettage in first trimester incomplete abortion.
Materials and Methods: Randomized trial included 121 participants with incomplete abortion at gestational age less than 14 weeks who underwent uterine curettage. They were randomly assigned into three groups: intravenous sedation (meperidine 50 mg and diazepam 10 mg), PCB (5 ml of 1% lidocaine injected at the 4 and 8 o’clock positions of cervix) and PCB plus 10% lidocaine spray 20 mg at the cervix. Pain score was measured using a numerical rating scale (0-10) before, during uterine curettage being undertaken, immediately and 30 minutes after the procedure. Adverse effects were observed and participants’ satisfactions were evaluated.
Results: Pain score during the uterine curettage was significantly different across the three treatment groups (median score of 5 in intravenous sedation group, 5 in PCB group, 4 in PCB plus spray group, p = 0.001). Further pairwise comparisons found significantly greater benefits on pain relief during the uterine curettage in PCB plus spray than both PCB and intravenous sedation groups (p = 0.001 and 0.002, respectively). Significant differences in pain scores across the three treatment groups were also observed immediately (p = 0.025), and 30 minutes after the procedure (p = 0.003). Satisfaction of pain relief was lower in the intravenous sedation than the PCB and PCB plus spray groups. The intravenous sedation group reported more nausea and dizziness, while the PCB group reported more symptoms of numbness than the other two groups.
Conclusion: Paracervical block plus 10% lidocaine spray had high efficacy in pain relief in incomplete abortion uterine curettage with fewer minor adverse effects of nausea and dizziness.
2. Abortion. In: Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS, eds. Williams Obstetrics. 24th ed. New York: McGrawHill-Education 2014:365-6.
3. Harris LH, Dalton VK, Johnson TR. Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care. Am J Obstet Gynecol 2007;196:445.e1-5.
4. Cansino C, Edelman A, Burke A, Jamshidi R. Paracervical block with combined ketorolac and lidocaine in first-trimester surgical abortion. Obstet Gynecol 2009;114:1220-6.
5. Renner RM, Nichols MD, Jensen JT, Li H, Edelman AB. Paracervical block for pain control in first-trimester surgical abortion: a randomized controlled trial. Obstet Gynecol 2012;119:1030-7.
6. Karasahin KE, Alanbay I, Ercan CM, Mesten Z, Simsek C, Başer I. Lidocaine spray in addition to paracervical block reduces pain during first-trimester surgical abortion: a placebo-controlled clinical trial. Contraception 2011;83:362-6.
7. López JC, Vigil-De Gracia P, Vega-Malek JC, Ruiz E, Vergara V. A randomized comparison of different methods of analgesia in abortion using manual vacuum aspiration. Int J Gynaecol Obstet 2007;99:91-4.
8. Gómez PI, Gaitán H, Nova C, Paradas A. Paracervical block in incomplete abortion using manual vacuum aspiration: randomized clinical trial. Obstet Gynecol 2004;103:943-51.
9. Egziabher TG, Ruminjo JK, Sekadde-Kigondu C. Pain relief using paracervical block in patients undergoing manual vacuum aspiration of uterus. East Afr Med J 2002;79:530-4.
10. Allen RH, Kumar D, Fitzmaurice G, Lifford KL, Goldberg AB. Pain management of first-trimester surgical abortion: effects of selection of local anesthesia with and without lorazepam or intravenous sedation. Contraception 2006; 74:407-13.
11. Chanrachakul B, Likittanasombut P, O-Prasertsawat P, Herabutya Y. Lidocaine versus plain saline for pain relief in fractional curettage: a randomized controlled trial. Obstet Gynecol 2001;98:592-5.
12. Glantz JC, Shomento S. Comparison of paracervical block techniques during first trimester pregnancy termination. Int J Gynaecol Obstet 2001;72:171-8.
13. Aksoy H, Aksoy U, Ozyurt S, Ozoglu N, Acmaz G, Aydın T, et al. Comparison of lidocaine spray and paracervical block application for pain relief during first-trimester surgical abortion: A randomised,double-blind, placebo-controlled trial. J Obstet Gynaecol 2016;36:649-53.
14. Sripha M, Charakorn C, Lekskul N, Lertkhachonsuk A. Analgesic Effect of Lidocaine Spray during Endometrial Biopsy: A randomized controlled trial. Thai J Obstet Gynaecol 2018;26:192-9.
15. Bélanger E, Melzack R, Lauzon P. Pain of first-trimester abortion: a study of psychosocial and medical predictors. Pain 1989;36:339-50.
16. Borgatta L, Nickinovich D. Pain during early abortion. J Reprod Med 1997;42:287-93.
17. Smith GM, Stubblefield PG, Chirchirillo L, McCarthy MJ. Pain of first-trimester abortion: its quantification and relations with other variables. Am J Obstet Gynecol 1979; 133:489-98.