Paracervical Block for Pain Control in First-Trimester Surgical Abortion: A Randomized Controlled Trial

Renner, Regina-Maria MD, MPH; Nichols, Mark D. MD; Jensen, Jeffrey T. MD, MPH; Li, Hong MD, MSPH; Edelman, Alison B. MD, MPH

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e318250b13e
Original Research
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.

CONCLUSION: 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.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094366.

LEVEL OF EVIDENCE: I

In Brief

The paracervical block reduces first-trimester abortion pain regardless of gestational age.

Author Information

From the Departments of Public Health and Preventive Medicine, School of Medicine, and Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.

Supported by the Oregon Health & Science Family Planning Fellowship Fund.

The authors thank Planned Parenthood of the Columbia Willamette and the Women's Health Research Unit of the Oregon Health & Science University for providing essential support in recruiting women and collecting data.

Presented at the North American FORUM on Family Planning October 24, 2011, Washington, DC.

The findings and conclusions in this article are those of the authors, and do not necessarily represent the views of Planned Parenthood Federation of America, Inc.

Corresponding author: Regina-Maria Renner, MD, MPH, Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, OR 97239; e-mail: rerenner@bluewin.ch.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.