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Paracervical block emerges as a reliable pain management option for early surgical abortions, underscoring the need for further evaluation of topical anesthesia's efficacy.
A novel review published in “BMJ Sexual and Reproductive Health” aimed to evaluate both the benefits and potential drawbacks of using local anesthesia to enhance patient comfort in case of surgical abortion before 14 weeks of pregnancy. Researchers conducted an extensive systematic review of studies published up to December 2022, focusing specifically on local anesthesia administered during uterine aspiration procedures. They employed the Cochrane Risk of Bias 2 (RoB2) tool to assess the quality of the included studies, along with the GRADE framework to determine the overall certainty of the evidence.
Key outcomes measured included intraoperative pain levels, patient satisfaction, and any adverse events related to the anesthesia. Thirteen studies involving nearly 2,000 participants met the criteria for inclusion, with most studies showing a low risk of bias. However, the variability in intervention protocols complicated efforts to conduct a meta-analysis. Notably, a randomized controlled trial (RCT) found that a 20 mL paracervical block (PCB) using Lidocaine 1% extremely decreased pain during dilation (mean difference of -37.00) and aspiration (mean difference of -26.00), compared to a sham PCB.
This high-certainty evidence guides that PCB may be an efficacious pain management choice. Additionally, another RCT demonstrated that a PCB using 14 mL of Chloroprocaine 1% provided a slight advantage in pain reduction during aspiration when compared to a normal saline PCB injected at various sites (mean difference of −1.50). Overall, participants reported a high level of satisfaction with any form of pain control employed, and adverse events were minimal, with few incidents linked to the medications used.
BMJ Sexual and Reproductive Health
Local anaesthesia for pain control in surgical abortion before 14 weeks of pregnancy: a systematic review
Regina Renner et al.
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