Paracervical Block With Combined Ketorolac and Lidocaine in First-Trimester Surgical Abortion

Cansino, Catherine; Edelman, Alison; Burke, Anne E.; Jamshidi, Roxanne

doi:10.1097/aog.0b013e3181c1a55b

Cited by 22 publications

(6 citation statements)

References 19 publications

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“…The results of this study showed that ketorolac reduced intraoperative opioid dosage not only intravenously, but by TAP blockade and that both modes of administration achieved the same effect with no difference in efficacy. This result is consistent with Qi Jiang et al [2] The BCS scores at different time points in the three groups showed that the combined TAP block with ketorolac and ropivacaine was superior to TAP block with ropivacaine alone or intravenous injection of ketorolac combined with TAP block with ropivacaine, which is consistent with the findings of some investigators [2,[8][9][10] , but different from the conclusions of others [11][12][13] . One possible reason for these results may due to the fact that the nerve block site is different.The site of block in the present study is TAP while the targets of those studies are brachial plexus nerve block or local infiltration of the surgical incision, respectively.Another reason maybe related to the different local anesthetic drugs used, both of which use lidocaine or bupivacaine while the local anesthetic used in the present study is ropivacaine.…”

Section: Discussionsupporting

confidence: 90%

Effects of Ropivacaine Combined with Ketorolac Transverse Abdominis Plane Block on Postoperative Analgesia in Patients Undergoing Gynecological Laparoscopic Surgery

Hao¹,

Xia²,

Li³

et al. 2021

JCMR

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Objective — To observe the effects of ropivacaine combined with ketorolac transverse abdominis plane (TAP) block on postoperative analgesia in patients undergoing gynecological laparoscopic surgery. Methods — 90 ASAⅠorⅡpatients, aged 18-65 years and weighting 40-80 kg, scheduled for gynecological laparoscopic surgery were recruited and divided into three groups using random number table:ropivacaine combined with ketorolac 15 mg/side for TAP block (KR group), ropivacaine for TAP block and 30 mg preoperatively intravenous ketorolac (KIVR group) and ropivacaine for TAP block alone (R group) with 30 patients in each group. Intraoperative opioid consumption, Bruggrmann comfort scale (BCS) scores at 2h (T1), 4h (T2), 8h (T3), 12h (T4), 16h (T5), 24h (T6) after surgery were recorded. Adverse reactions such as nausea and vomiting, respiratory depression, local anesthetic poisoning, gastrointestinal bleeding, and complications related to TAP block operation were recorded. Results — The total consumpsion of sufentanil was higher in the R group than that in the KIVR group and KR group (P < 0.05). The total dosage of remifentanil in R group was higher than that in KR group (P < 0.05). The BCS scores of the three groups at T3, T4, T5 and T6 were lower in R group than that in KR group (P < 0.05) while R Group was lower than KIVR group at T3 and T4 (P < 0.05), and KIVR group was lower than KR group at T5 and T6. There was no statistically differences in BCS score between the three groups at T1 and T2 (P > 0.05). No statistical differences in the incidence of adverse reactions among all groups were observed. Conclusion — Ropivacaine combined with ketolorac transverse abdominisplane block reduced the intraoperative opioid consumption, improved postoperative comfort score and do not increased the incidence of adverse reactions in gynecological laparoscopic surgery.

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Section: Discussionsupporting

confidence: 90%

Effects of Ropivacaine Combined with Ketorolac Transverse Abdominis Plane Block on Postoperative Analgesia in Patients Undergoing Gynecological Laparoscopic Surgery

Hao¹,

Xia²,

Li³

et al. 2021

JCMR

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“…An RCT of 50 women undergoing first-trimester abortion at less than 11 weeks' gestation compared ibuprofen 600 mg PO and 1% lidocaine PCB to a combination of ketorolac 30 mg intracervical and 1% lidocaine PCB; both groups received lorazepam 2 mg sublingually. Women reported less pain during cervical dilation with the combined ketorolac and lidocaine block (mean 5.9 cm vs. 7.4 cm, VAS; pb.05), but scores were similar for procedure-related pain, postoperative pain and satisfaction with pain control (90% power to detect 20-mm difference on the VAS) [46]. In another RCT, 94 women undergoing surgical abortion at less than 12 weeks with local anesthesia were allocated to ibuprofen 800 mg PO given 60-90 min preprocedure or ketorolac 60 mg IM 30-60 min preprocedure [65].…”

Section: What Is the Role Of Nonsteroidal Anti-inflammatory Drugs (Nsmentioning

confidence: 93%

“…Women receiving local cervical anesthesia alone for firsttrimester surgical abortion report, on average, experiencing moderate pain ranging from 4 to 7 out of 10 [19,[42][43][44][45][46] compared to 8 to 9 out of 10 with sham local cervical anesthesia [21]. The PCB anesthetizes the nerve bundles lateral to the cervix at 3 o'clock and 9 o'clock as well as those within the uterosacral ligaments.…”

Section: Is Local Anesthesia Effective For Pain Control In Surgical Amentioning

confidence: 99%

Society of Family Planning clinical guidelines pain control in surgical abortion part 1 — local anesthesia and minimal sedation

Allen

Singh

2018

Contraception

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Satisfactory pain control for women undergoing surgical abortion is important for patient comfort and satisfaction. Clinicians ought to be aware of the safety and efficacy of different pain control regimens. This document will focus on nonpharmacologic modalities to reduce pain and pharmacologic interventions up to the level of minimal sedation. For surgical abortion without intravenous medications, a multimodal approach to pain control may combine a dedicated emotional-support person, visual or auditory distraction, administration of local anesthesia to the cervix with buffered lidocaine and a preoperative nonsteroidal anti-inflammatory drug. Oral opioids do not decrease procedural pain. Oral anxiolytics decrease anxiety but not the experience of pain. Further research is needed on alternative options to control pain short of moderate or deep sedation.

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“…Sample size was based on mean procedure pain scores from current evidence. Previous studies of first trimester abortion under local anesthesia with or without ibuprofen demonstrate mean VAS between 51-62 mm with standard deviations (SD) of 22-25 mm [10][11][12]. Clinically important mean differences in pain are 13-20 mm on the VAS [8,10,11,13].…”

Section: Methodsmentioning

confidence: 99%

Nitrous Oxide Versus Oral Sedation for Pain Management of First-Trimester Surgical Abortion—A Randomized Study

Singh

Montoya

Espey

et al. 2017

Obstetrical &Amp; Gynecological Survey

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Objectives-To compare nitrous oxide with oxygen (N 2 O/O 2 ) to oral hydrocodone/ acetaminophen and lorazepam (oral) for analgesia during first-trimester surgical abortion.Study Design-This double-blind randomized trial assigned women undergoing first-trimester surgical abortion at < 11 weeks' gestation to inhaled N 2 O/O 2 vs. oral sedation for pain management. The N 2 O/O 2 group received up to 70:30 ratio during the procedure and placebo pills pre-procedure; the oral group received inhaled oxygen during the procedure and oral hydrocodone/ acetaminophen 5 mg/325 mg and lorazepam 1 mg pre-procedure. The primary outcome was maximum procedural pain, assessed on a 100-mm Visual Analog Scale (VAS; anchors 0 = no pain and 100 = worst pain) at two-minutes post procedure. A difference of 13 mm on the VAS was considered clinically significant. Satisfaction with pain management was measured on a 100-mm VAS (anchors 0 = very unsatisfied, 100 = very satisfied).Results-We randomized 140 women, 70 per study arm. Mean age of participants was 26 ± 6.6 years; mean gestational age was 7.3 ± 1.5 weeks. Mean maximum procedure pain scores were 52.5 ± 26.7 and 60.8 ± 24.4 for N 2 O/O 2 and oral groups, respectively (p=0.09). Satisfaction with

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Paracervical Block With Combined Ketorolac and Lidocaine in First-Trimester Surgical Abortion

Abstract: I.

Cited by 22 publications

References 19 publications

Effects of Ropivacaine Combined with Ketorolac Transverse Abdominis Plane Block on Postoperative Analgesia in Patients Undergoing Gynecological Laparoscopic Surgery

Effects of Ropivacaine Combined with Ketorolac Transverse Abdominis Plane Block on Postoperative Analgesia in Patients Undergoing Gynecological Laparoscopic Surgery

Society of Family Planning clinical guidelines pain control in surgical abortion part 1 — local anesthesia and minimal sedation

Nitrous Oxide Versus Oral Sedation for Pain Management of First-Trimester Surgical Abortion—A Randomized Study

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