Raymonde Moullier
Speeches:
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First trimester surgical abortion under local anaesthesia
Raymonde MOULLIER, Vice-President of ANCIC www.ancic.asso.fr; Martine Hatchuel,
Sylvie Osterreicher, Nathalie Trignol
CIVG S. Veil, CHU de Nantes and CIVG C. Vautier, clinique J. Verne, Nantes, France
In France, abortion was legalized in 1975, and suction vacuum aspiration under local
anesthesia (LA) became prevalent especially in non-hospital autonomous clinics. As the
government decided to integrate abortion units within hospitals, surgical abortion under
local anesthesia decreased while the use of general anesthesia increased particularly for
the 12 to 14 weeks of amenorrhea. This trend seems to be occurring throughout Europe.
However, aspiration under LA remains a reliable technique for well trained personnel,
and ideal for the woman who chose LA when it is combined with psychological guidance
and an empathetic staff. This support is of prime importance in patience comfort and
satisfaction.
Moreover, since 1975, improvements have been made in the procedure:
cervical priming with misoprostol 400µg 2 or 3 hours before suction or even better with 200
mg of mifepriston 36 or 48 hours before suction, or with association of mifepriston and
misoprostol, especially for the 12 to 14 weeks of amenorrhea.
local anesthesia with lignocaïne 1% or lignocaïne + adrenalin by local infiltration of the
cervix or paracervical block or both is used routinely.
Treatment with ibuprofen (400 mg) 2 hours before suction helps prevent the pain during
the uterin contraction at the end of the procedure. Consequently, pain is either not
perceived or is tolerable for most women.
As adjunct analgesia, some providers are now using auto – inhalation of nitrous oxide and
some practice acupuncture.
All these improvements coupled with attention and empathy from the staff should give LA
a primary place in abortion practice. LA should be routinely proposed to women, and
medical teams trained in the technique.