Nathalie Ambassa
Speeches:
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Paracervical block versus intracervical injection for pain management during first-trimester surgical abortion under local anaesthesia
Nathalie Ambassa, K. Bourzoufi, Francis Collier (France)
Orthogenics and medicine of the couple department, Hôpital Jeanne de Flandre, CHRU Lille, France
nathalieambassa@yahoo.fr
Objective.Two different local anaesthesia techniques are commonly used for pain relief during first-trimester surgical abortion: paracervical block (PCB) or intracervical injection (ICI). The superiority of one technique versus the other has not been clearly established. In practice, the choice between these two techniques is made empirically, according to specific habits of each centre or each practitioner. This prospective observational study compared the effectiveness and acceptability of these two techniques to reduce pain during first-trimester surgical abortion following cervical priming with misoprostol.
Patients and methods. Two-hundred and forty-nine women undergoing suction evacuation up to 12 weeks gestation were randomized into two groups: (ICI) 5 mL of 2% lidocaine injected at the 4 and 8 o’clock positions of the cervix; (PCB) 10 mL of 1% lidocaine injected at the 4 and 8 o’clock positions of the vaginal vault. Using a 0-10 scale, women rated pain associated with local anaesthetic administration, cervical dilatation and during and after suction evacuation. Pain scores, post-operative analgesic demand and satisfaction levels were compared among the two groups.
Results.Pain levels during local anaesthetic administration were significantly lower (p<0.0001) in the paracervical group (2.1±2.1) than in the intracervical group (3.9±2.4). There were no statistically significant differences in the pain scores during cervical dilatation and suction evacuation. Post-operative demand for analgesics was significantly (p=0.0286) higher in the intracervical group. There was no difference between the groups concerning the global satisfaction of the patients (p=0.2489).
Conclusion. The paracervical block is less painful and at least as effective against the pains related to the cervical dilatation as the intracervical injection. Therefore, the paracervical block seems to be the technique of choice in first-trimester surgical abortion under local anaesthesia. This study should lead to a modification of our practice in Lille with a broader use of the paracervical block for our patients.
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Presenting a recent review
Nathalie Ambassa, K. Bourzoufi, Francis Collier (France)
Orthogenics and medicine of the couple department, Hôpital Jeanne de Flandre, CHRU Lille, France
nathalieambassa@yahoo.fr
Objective. Two different local anaesthesia techniques are commonly used for pain relief during first-trimester surgical abortion: paracervical block (PCB) or intracervical injection (ICI). The superiority of one technique versus the other has not been clearly established. In practice, the choice between these two techniques is made empirically, according to specific habits of each centre or each practitioner. This prospective observational study compared the effectiveness and acceptability of these two techniques to reduce pain during first-trimester surgical abortion following cervical priming with misoprostol.
Patients and methods. Two-hundred and forty-nine women undergoing suction evacuation up to 12 weeks gestation were randomized into two groups: (ICI) 5 mL of 2% lidocaine injected at the 4 and 8 o’clock positions of the cervix; (PCB) 10 mL of 1% lidocaine injected at the 4 and 8 o’clock positions of the vaginal vault. Using a 0-10 scale, women rated pain associated with local anaesthetic administration, cervical dilatation and during and after suction evacuation. Pain scores, post-operative analgesic demand and satisfaction levels were compared among the two groups.
Results. Pain levels during local anaesthetic administration were significantly lower (p<0.0001) in the paracervical group (2.1±2.1) than in the intracervical group (3.9±2.4). There were no statistically significant differences in the pain scores during cervical dilatation and suction evacuation. Post-operative demand for analgesics was significantly (p=0.0286) higher in the intracervical group. There was no difference between the groups concerning the global satisfaction of the patients (p=0.2489).
Conclusion. The paracervical block is less painful and at least as effective against the pains related to the cervical dilatation as the intracervical injection. Therefore, the paracervical block seems to be the technique of choice in first-trimester surgical abortion under local anaesthesia. This study should lead to a modification of our practice in Lille with a broader use of the paracervical block for our patients.