title: Intrauterine lidocaine for pain control during laminaria insertion: a randomized controlled trial.
abstract: OBJECTIVE
  To determine if intrauterine administration of 5 cc of 2% lidocaine in addition to paracervical block reduces pain during laminaria insertion, when compared with paracervical block and saline placebo.
  
  
  METHODS
  This was a randomized, double blind placebo-controlled trial. Women presenting for abortion by dilation and evacuation (D&E) at 14-24 weeks gestational age were randomized to receive an intrauterine instillation of either 5 mL of 2% lidocaine or 5 mL of normal saline, in addition to standard paracervical block with 20 cc of 0.25% bupivacaine. Our primary outcome was self-reported pain scores on a 100mm Visual Analogue Scale (VAS) immediately following laminaria insertion. Secondary outcome was self-reported VAS pain score indicating the maximum level of pain experienced during the 24-48-h interval between laminaria insertion and D&E procedure.
  
  
  RESULTS
  Seventy-two women were enrolled, and data for 67 women were analyzed, only two of whom were more than 21 weeks on gestation. The range of pain scores at both time points was large (1-90 mm at laminaria insertion; 0-100mm in laminaria-D&E interval). Mean pain scores were not different between treatment groups at laminaria insertion, (33 vs. 32, p=.8) or in the laminaria - D&E interval (43 vs. 44, p=.9).
  
  
  CONCLUSIONS
  Intrauterine administration of 5 cc of 2% lidocaine in addition to paracervical block did not reduce pain with laminaria insertion when compared to paracervical block with saline placebo.
  
  
  CONCLUSIONS
  Intrauterine lidocaine combined with paracervical block does not improve pain control at laminaria insertion when compared with paracervical block and saline placebo. Wide variation in pain scores and persistent pain after laminaria insertion suggests patient would benefit from more effective methods of pain control at laminaria insertion and during the post-laminaria interval.
authors.affiliation: Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: Rebecca.mercier@jefferson.edu.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mercier
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Liberty
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007795:Laminaria; D008012:Lidocaine / Q000008:administration & dosage* / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011247:Pregnancy; D014599:Uterus / Q000187:drug effects
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Abortion; Anesthesia; Cervical preparation; Dilation and evacuation