title: Self-Administered Lidocaine Gel for Pain Control With First-Trimester Surgical Abortion: A Randomized Controlled Trial.
abstract: To compare pain control at various time points during first-trimester surgical abortion using a patient-administered lidocaine gel compared with a traditional lidocaine paracervical block.
  
  
  
  We conducted a randomized controlled trial of women undergoing surgical abortion at less than 12 weeks of gestation in an outpatient setting. The primary outcome was pain at cervical dilation as measured on a 100-mm visual analog scale. A sample size of 142 participants was planned to detect a 15-mm or greater difference on the 100-mm visual analog scale with 90% power and a significance level of .025, adding 10% for participant dropout and protocol violations. Participants received either 12 mL of a 1% lidocaine paracervical block or 20 mL of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. Secondary outcomes included anticipated pain, baseline pain, pain with speculum and tenaculum placement, pain after suction aspiration, and pain 30-45 minutes postoperatively.
  
  
  
  From April to October 2015, a total of 142 women were enrolled (68 in the paracervical block group, 69 in the gel group, and five not analyzed as a result of participant withdrawal). Sociodemographic characteristics were similar between groups. The mean pain score with cervical dilation was 60 mm (95% confidence interval [CI] 54-66) in the paracervical block group and 64 mm (95% CI 59-69) in the gel group (P=.3). There was no significant difference between mean pain scores at any time points measured.
  
  
  
  Self-administration of lidocaine gel before first-trimester surgical abortion is noninferior to a traditional paracervical lidocaine block and should be considered as an alternative, noninvasive approach to pain control for first-trimester surgical abortion.
  
  
  
  ClinicalTrials.gov, https://clinicaltrials.gov, NCT02447029.
authors.affiliation: Department of Obstetrics & Gynecology, Division of Family Planning Services & Research, Stanford University, Stanford, California.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Conti
authors.forename: Klaira
authors.initials: K
authors.lastname: Lerma
authors.forename: Kate A
authors.initials: KA
authors.lastname: Shaw
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blumenthal
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012646:Self Administration; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine