title: Paracervical block for pain control in first-trimester surgical abortion: a randomized controlled trial.
abstract: OBJECTIVE
  Despite lack of efficacy data, the majority of first-trimester surgical abortions are performed with a paracervical block. Women may be unnecessarily exposed to a painful injection and potentially noxious medication. Our objective was to estimate the effect of a paracervical block and the effect of gestational age on patient pain perception.
  
  
  METHODS
  This was a randomized, single-blind trial of patients undergoing abortion receiving paracervical block or sham stratified by gestational age (early: less than 8 weeks of gestation, n=60; late: 8-10 6/7 weeks of gestation, n=60). Premedicated with ibuprofen and lorazepam, all participants received 2 mL 1% buffered lidocaine injected at the tenaculum site followed by a slow, deep injection of 18 mL at four sites (block) or no injection (sham) with a 3-minute wait. The primary outcome was dilation pain (100-mm visual analog scale). Secondary outcomes included pain at additional time points, satisfaction, need for more analgesics, and adverse events.
  
  
  RESULTS
  Full enrollment occurred (n=120). We used intent-to-treat analysis. Demographics did not differ between groups. Paracervical block administration was painful (mean 55 mm compared with sham 30 mm, P<.001) but decreased dilation pain (42 mm compared with 79 mm, P<.001) and aspiration pain (63mm compared with 89 mm, P<.001). These results were consistent for both gestational age strata; however, paracervical block benefit was greater at an earlier gestation. Satisfaction scores with pain control and the procedure were significantly higher in the block group.
  
  
  CONCLUSIONS
  Although paracervical block is painful, it reduces first-trimester abortion pain regardless of gestational age, but the benefit on dilation pain was greater at earlier gestations.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094366.
  
  
  METHODS
  I.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA. rerenner@bluewin.ch
authors.forename: Regina-Maria
authors.initials: RM
authors.lastname: Renner
authors.forename: Mark D
authors.initials: MD
authors.lastname: Nichols
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Jensen
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.forename: Alison B
authors.initials: AB
authors.lastname: Edelman
mesh_terms: D000028:Abortion, Induced / Q000379:methods; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D000779:Anesthetics, Local / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006801:Humans; D057194:Intention to Treat Analysis; D008012:Lidocaine / Q000627:therapeutic use*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D058748:Pain Perception; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine