Introduction Pain perception is a complex phenomenon that impacts the selection of analgesia. The majority of first-trimester surgical abortions in United States are performed with a paracervical block (PCB). Satisfactory pain control for women undergoing surgical abortion is important for patient comfort and satisfaction. Aim of the work The aim of this study was to estimate the pain related to first-trimester abortion under local or general anesthesia. Patients and methods A hundred female patients (American Society of Anesthesiologists)(ASA) I-II undergoing dilatation and curettage were randomly allocated into two equal groups. Group A (n=50): they received a PCB with 5 ml of 2% lidocaine injected into each side of cervix at the 3 and 9 o'clock positions. Group B (n=50): they received general anesthesia with intravenous bolus of 2.5 to 4 mg/kg propofol and 1 µg/kg fentanyl, and maintained anesthesia by 1 mac isoflorine in oxygen as inhalational anesthesia by face mask. Results The study showed that the most commonly prevalent type of pain by the visual analog scale is in group A during aspiration, curettage, and immediately postoperatively as 41; 27 and 48 patients felt mild pain, respectively; while during dilatation increase incidence of moderate pain as 26 (52%) patients felt moderate pain. Conclusion The PCB is more preferred than general anesthesia under condition that we wait a few minutes before beginning the procedure as it insures the satisfaction of the patient while avoiding the side effects of general anesthesia and is also not as expensive.