Obstetrics & Gynecology, 2017, Vol.130(2), pp.387-392
OBJECTIVE:: To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion. METHODS:: In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm. RESULTS:: From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2–39] compared with 54 mm [interquartile range 27–61], P=.01, 95% CI −47.0 to −4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78–100] compared with 70 mm [interquartile range 44–90], P=.05, 95% CI 0.0–37.0). CONCLUSION:: Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, NCT02454296.
Abortion, Induced–Methods ; Adult–Methods ; Anesthesia, Obstetrical–Administration & Dosage ; Double-Blind Method–Administration & Dosage ; Female–Administration & Dosage ; Gestational Age–Administration & Dosage ; Hawaii–Administration & Dosage ; Humans–Administration & Dosage ; Laminaria–Administration & Dosage ; Lidocaine–Administration & Dosage ; Pain Measurement–Administration & Dosage ; Patient Satisfaction–Administration & Dosage ; Pregnancy–Administration & Dosage ; Pregnancy Trimester, Second–Administration & Dosage ; Sodium Bicarbonate–Administration & Dosage ; Abridged ; Sodium Bicarbonate ; Lidocaine;