Pre-ovarian block versus paracervical block for oocyte retrieval

Cerne, A.; Bergh, Christina; Borg, Kia; Ek, Ingvar; Gejervall, Ann-Louise; Hillensjø, Torbjörn; Olofsson, Jan I.; Stener-Victorin, Elisabet; Wood, M.; Westlander, Göran

doi:10.1093/humrep/del271

Cited by 23 publications

(12 citation statements)

References 22 publications

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“…Assuming the mean overall pain in the RN group to be 27 mm (value chosen after analysis of data from a previous study from our group, Cerne et al ., 2006) on VAS, with a standard deviation (SD) of 21.5 mm (based on analysis of data from a previous study Cerne et al ., 2006), 121 patients in each group would be needed to demonstrate a decrease in overall pain of 8 mm (30%) with 80% power and a significance level of 0.05 (two-tailed tests).…”

Section: Methodsmentioning

confidence: 99%

A randomized controlled study comparing pain experience between a newly designed needle with a thin tip and a standard needle for oocyte aspiration

Wikland

Blad

Bungum³

et al. 2011

Human Reproduction

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BACKGROUNDUltrasound-guided transvaginal oocyte retrieval is often performed under local anaesthesia on an outpatient basis. The objective of this study was to compare the overall pain experience of a newly designed reduced needle (RN) compared with a thicker standard needle (SN).METHODSA prospective, randomized, multi-centre study was performed at four different clinics from June to December 2009. The oocyte aspiration was performed under local anaesthesia, either with a needle with a reduced diameter (0.9 mm) for the last 50 mm from the tip (RN) or with a SN (1.4 mm). A total of 257 patients were randomized (RN: n = 129; SN: n = 128). The primary endpoint was the overall pain experience self-assessed and registered by the patient on a visual analogue scale (VAS 0 mm = no pain to 100 mm = unbearable pain) immediately after the oocyte retrieval. Secondary end-points such as vaginal bleeding and several embryological parameters were also registered.RESULTSThe overall pain during the oocyte retrieval procedure was significantly lower in the RN group than in the SN group (mean 21.0 mm, SD 17.5 mm and median 19.0 mm versus mean 26.0 mm, SD 19.9 mm and median 24.0 mm; P = 0.040, difference between groups mean−5.0 mm, 95% CI: 9.7 to−0.4). This was also true when adjusting for baseline characteristics such as number of follicles, number of previous oocyte pick-up, body mass index and age, by a multiple linear regression analysis. Significantly more patients (40 of 126) had less than expected vaginal bleeding in the RN group when compared with the SN group (24 of 124; 32 versus 19%; P = 0.03 and 95% CI 1.7–23.0%). No differences were found between the two needles with regard to additional i.v. analgesia, aspiration time, oocyte recovery, fertilization, cleavage rate, number of good quality embryos, number of embryos for freezing and pregnancy rate.CONCLUSIONSOocyte aspiration performed with the newly designed thinner-tipped needle resulted in significantly less overall pain and less vaginal bleeding, without prolonging the retrieval procedure or influence the oocyte recovery rate, when compared with a SN.Clinicaltrials.gov: NCT00924885

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Section: Methodsmentioning

confidence: 99%

A randomized controlled study comparing pain experience between a newly designed needle with a thin tip and a standard needle for oocyte aspiration

Wikland

Blad

Bungum³

et al. 2011

Human Reproduction

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“…According to a cohort study based on analysis of patient records at Mirza Kochak Khan Hospital, Tehran University of Medical Sciences (Aghaamoo et al, 2014), it was recommended to use spinal anesthesia instead of GA for oocyte retrieval, to achieve successful in vitro fertilization outcome [ 2 ]. Nerve blocks (ovarian block and paracervical block) as an additional method for pain relief proved no harm on the IVF success [ 3 , 4 ]. Epidural anesthesia is not commonly used but it seems a safe alternative choice, as it was not associated with toxic effects [ 5 ].…”

Section: Resultsmentioning

confidence: 99%

“…Epidural anesthesia and sedation (propofol and mask-assisted ventilation with nitrous oxide) had the same outcomes in terms of pregnancy [ 5 ]. No difference was found between performing preovarian block and paracervical local anesthetic block for oocyte retrieval [ 4 ].…”

Section: Resultsmentioning

confidence: 99%

Anesthesia Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof

Matsota

Kaminioti

Kostopanagiotou

2015

BioMed Research International

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Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly associated with toxicity. MAC and Loco-regional anesthesia appear as safe alternative choices and there is evidence of improved outcome. Whereas acupuncture may provide assistance increasing IVF success according to some trials, some others could not obtain these effects. Questions about the appropriate time of application and the underlying mechanism of action are not answered yet, so further investigation should be done.

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“…Here it becomes customary for the anesthetist to provide adequate pain relief to immobilize the patient and eliminate the danger of piercing any vessels during the process of oocyte retrieval. The ideal pain relief during oocyte retrieval should be effective and safe, easy to administer and monitor, short acting and readily reversible with few side effects [15,16].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the applied technique of intravenous anesthesia for in vitro fertilization in obese and patients with normal body mass index

Videnović¹,

Mladenović²,

Pavlović³

et al. 2019

Srp Arh Celok Lek

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Introduction/Objective In this study, the effects of applied anesthetic techniques were investigated in a retrospective analysis of obese patients and those with normal body mass index undergoing in vitro fertilization, using bispectral index as an indicator of anesthetic depth. Methods In total 116 patients with normal body mass index were allocated to group N. Another 116 patients with body mass index > 30 kg/m 2 were allocated to group O. Anesthetic protocol comprised midazolam for premedication, diclofenac for pre-emptive analgesia, propofol for induction and maintenance, alfentanil for analgesia, suxamethonium for muscle relaxation. We recorded and compared the monitored parameters using t-test and χ 2 test. Results Procedure duration and recovery time were significantly longer in O group (p < 0.01). There is a statistically significant difference (p = 0.000181) in the number of patients requiring mechanical ventilation after induction of anesthesia. Propofol consumption was significantly higher (p < 0.0001) in O group (2.7 ± 1.6 mg/kg) as compared to group N (2.1 ± 0.4 mg/kg). The incidence of postoperative nausea and vomiting was observed in six patients in N group (5.17%) and nine patients in O group (7.76%). Pain intensity was found higher in group O compared to group N (p < 0.0001). Assessment of patients' sedation using verbal scale reported no statistically significant difference between N and O groups (p = 0.2548). Conclusion Induction and maintenance of anesthesia in obese patients results in increased consumption of propofol and the need for muscle relaxation. The statements of the patients who underwent the procedure under intravenous propofol and alfentanil serve as the best recommendation for clinical practice.

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Pre-ovarian block versus paracervical block for oocyte retrieval

Abstract: No differences were found in overall pain experienced during the entire oocyte retrieval procedure with POB compared to PCB.

Cited by 23 publications

References 22 publications

A randomized controlled study comparing pain experience between a newly designed needle with a thin tip and a standard needle for oocyte aspiration

A randomized controlled study comparing pain experience between a newly designed needle with a thin tip and a standard needle for oocyte aspiration

Anesthesia Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof

Analysis of the applied technique of intravenous anesthesia for in vitro fertilization in obese and patients with normal body mass index

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