Refining paracervical block techniques for pain control in first trimester surgical abortion: a randomized controlled noninferiority trial

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

“…Similarly, in another RCT of 163 women, a four-site (2, 4, 8 and 10 o'clock) paracervical injection and a two-site (4 and 8 o'clock) paracervical injection were clinically equivalent for cervical dilation pain (mean 6.0 cm vs. 6.8 cm, VAS; p=.03) [56]. While one trial reported that waiting less than 2 min between block administration and procedure was associated with increased pain [17], other studies have not found that waiting 3 min decreases pain in a clinically significant manner [42,56,57].…”

“…Three minutes elapsed before cervical dilation began. Women who received PCB reported significantly less pain with both dilation (mean 4.2 cm vs. 7.9 cm, VAS; pb.001) and aspiration (mean 6.3 cm vs. 8.9 cm, VAS; pb.001) than women in the sham group [21]. Satisfaction scores with pain control and the procedure were higher in the active PCB arm.…”

“…Some, but not all, studies have found that young patient age, retroverted uterus, history of dysmenorrhea and gestational age (≤7 weeks vs. ≥12 weeks) are predictors of increased pain [12,14,15,18]. Several studies examining patients' experience of pain during first-trimester surgical abortion under local anesthesia report mean pain scores between 4 and 7 on a scale of 0-10 [16,[19][20][21]. For descriptive categories, 1055 women reported the following levels of pain: 1.5%, none; 5.7%, hardly any; 14.2%, a little; 20.3%, medium; 31.7%, quite a bit; and 26.4%, severe [15].…”

“…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.…”

“…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. In a randomized controlled trial of 120 women undergoing surgical abortion at less than 11 weeks [21], a PCB with 20 mL of 1% buffered lidocaine was compared to a sham PCB. In both arms, 2 mL of 1% buffered lidocaine was injected at the tenaculum site.…”