Paracervical block as pain treatment during second-trimester medical termination of pregnancy: an RCT with bupivacaine versus sodium chloride

Andersson, Inga-Maj; Benson, Lina; Christensson, Kyllike; Gemzell‐Danielsson, Kristina

doi:10.1093/humrep/dev286

Cited by 10 publications

(15 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17 Seven studies reported results from medical TOP (Figure 2; see Tables 1 and Table S1) among 453 participants hailing from Europe (five studies), Canada (one study) and Thailand (one study). 17,[19][20][21][22] The mean gestational age ranged from 16 to 22 weeks. Indications for TOP were described in six studies: in one, all TOPs were performed for fetal indications; 17 in another study, 80% were performed for fetal indications; 22 in three studies, fewer than half of the TOPs were performed for fetal indications; 19,21,24 and one study reported that all TOPs were 'indicated,' but did not specify those indications.…”

Section: Resultsmentioning

confidence: 99%

“…20 TOP was induced with mifepristone plus misoprostol in two studies, 19,21 misoprostol alone was used in three studies, 20,23,24 and gemeprost was used in two studies. 17,22 To report women's pain, six studies used an 11-point visual analogue scale (VAS), 17,[19][20][21][22]24 and one used an 11-point verbal scale; 23 two studies reported participant satisfaction with pain management using a visual or verbal scale. 22,23 Five studies reported the need for additional opioid pain medications for the participants beyond those of the study interventions; 17,[19][20][21]24 in contrast, studies using regional analgesia reported the overall consumption of pain medications or the need for additional anxiolytic medication.…”

Section: Resultsmentioning

confidence: 99%

“…17,19 One RCT compared PCB with 20 ml of 0.25% bupivacaine against saline placebo, administered 1 hour after the first misoprostol dose of a combined mifepristone and misoprostol medical TOP regimen. 19 The proportion of women reporting severe pain (pain ≥ 7 on an 11-point VAS: PCB = 75%, placebo = 65%, P = 0.292) and the use of additional pain medication (median morphine: PCB = 5 mg, placebo = 6 mg, P = 0.772) did not differ between groups. A second, nonrandomised trial compared bupivacaine PCB against no block in women undergoing medical TOP with gemeprost.…”

Section: Local Anesthesiamentioning

confidence: 99%

See 2 more Smart Citations

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Jackson¹,

Kapp²

2020

BJOG

View full text Add to dashboard Cite

Background High‐quality care for termination of pregnancy (TOP) requires pain to be effectively managed; however, practices differ, and the available guidelines do not specify optimal strategies. Objective To guide providers in effective pain management for second‐trimester medical and surgical TOP. Search strategy We searched PubMed, Cochrane and Embase databases, and the US National Library of Medicine clinical trials registry, from inception to the end of June 2019, and hand‐searched reference lists. Selection criteria Trials comparing pain management strategies with no treatment, placebo or active interventions during induced medical or surgical TOP, occurring between 13 and 24 weeks of gestation, and reporting direct or indirect measures of pain. Data collection and analysis Both authors summarised and systematically assessed the evidence and risk of bias using standard tools. Main results We included seven medical and four surgical TOP studies, with 453 and 349 participants, respectively. The heterogeneity of interventions and outcomes prevented pooled analyses. Medical TOP: women receiving routine or continuous epidural analgesia experienced mild pain. The prophylactic use of nonsteroidal anti‐inflammatory drugs (NSAIDs) decreased pain (mean difference −0.5, P < 0.001) and additional opioid requirements (3.5 versus 7 mg, P = 0.04) compared with placebo/other treatment. Paracervical block was ineffective. No studies assessed intramuscular (IM)/intravenous (IV) opioid or nonpharmacological treatment. Surgical TOP: general anaesthesia/deep IV sedation alleviated pain. Nitrous oxide was ineffective. No studies assessed moderate IV sedation, IV/IM opioid, paracervical block without sedation, NSAID or nonpharmacological treatment. Conclusion Based on limited data, regional analgesia and NSAIDs mitigated second‐trimester medical TOP pain; general anaesthesia/deep IV sedation alleviated surgical TOP pain. Tweetable abstract Although women experience intense pain during second‐trimester termination of pregnancy, few data are available to inform their treatment.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Local Anesthesiamentioning

confidence: 99%

See 1 more Smart Citation

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Jackson¹,

Kapp²

2020

BJOG

View full text Add to dashboard Cite

show abstract

“…When presented with this opportunity, their decisions are based on rational information and fears related to the procedure, including fear of pain (Kanstrup, Mäkelä, & Hauskov Graungaard, ). Indeed, those who undergo medical or surgical abortion are at risk of intense physical pain (Andersson, Benson, Christensson, & Gemzell‐Danielsson, ; Andersson, Christensson, & Gemzell‐Danielsson, ; Jackson & Kapp, ; Lafarge, Mitchell, & Fox, ; Renner, Jensen, Nichols, & Edelman, ) and sufficient pain management is emphasized in the literature (Bygdeman et al, ; Dennis, Blanchard, & Bessenaar, ; Royal College of Obstetricians & Gynaecologists, ).…”

Section: Introductionmentioning

confidence: 99%

Pain and pain management during induced abortions: A web‐based exploratory study of recollections from previous patients

Georgsson

Carlsson

2019

Journal of Advanced Nursing

View full text Add to dashboard Cite

Aims To explore recollections of pain and pain management during induced abortions. Design Mixed‐methods exploratory study in Sweden. Methods A web‐based survey was distributed between October 2017 ‐ July 2018 via Swedish discussion boards and social media. Open‐ended questions were asked about recollection of pain and pain management, followed by self‐reported ratings. The survey was answered by 185 participants, responses were analysed with qualitative content analysis. Findings Recollections of pain intensity illustrated considerable pain and a traumatic event, described in temporal aspects and likened to other painful conditions such as dysmenorrhoea and childbirth. Recollections of pain management illustrated experiences of insufficient treatment of pain and dissatisfaction with pain management, including inefficient treatment and lack of professional attendance. Psychological aspects and consequences illustrated that participants related psychological distress to physical pain, felt unprepared for the physical pain and emphasized the importance of psychological support. Those who experienced intense pain described long‐term psychological consequences, including fear of childbirth. Conclusion Physical pain and psychological distress can manifest as considerable challenges during induced abortion. Abortion‐related pain is a multidimensional phenomenon involving physical and psychological components that needs to be rigorously treated. When physical pain is unsuccessfully treated, women may experience long‐term psychological consequences after an abortion. Impact The results illustrate the importance of holistic abortion care where the multidimensional components of abortion‐related pain are considered. Patients need to be offered sufficient preparatory information about potential physical pain and psychological distress. This study indicates that there is room for improvement in pain management. Larger studies are needed.

show abstract

“…Individuals who undergo medically induced second-trimester abortions experience both emotional distress and physical pain before, during, and after the abortion [15-19]. To deal with their difficult situation, they have a great need for information and support [15-18].…”

Section: Introductionmentioning

confidence: 99%

Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues

Carlsson

Axelssön

2017

J Med Internet Res

View full text Add to dashboard Cite

BackgroundPatients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites.ObjectiveOur objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations.MethodsWe set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48% (628/1300) were irrelevant and 51% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues.ResultsThe interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57% (24/42) were rated as very unsuitable by at least one assessor. The most reported issues with the websites involved lack of information (76%, 32/42), and poor design (36%, 15/42).ConclusionsThe high number of irrelevant hits and poor quality of patient information websites are considerable issues that must be addressed and considered when consulting patients awaiting medically induced second-trimester abortions. In clinical encounters, health professionals should initiate discussions concerning websites about medically induced second-trimester abortions and inform patients about the issues and quality deficits associated with these websites.

show abstract

Paracervical block as pain treatment during second-trimester medical termination of pregnancy: an RCT with bupivacaine versus sodium chloride

Abstract: 29 May 2012.

Cited by 10 publications

References 31 publications

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Pain and pain management during induced abortions: A web‐based exploratory study of recollections from previous patients

Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues

Contact Info

Product

Resources

About