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Local anaesthesia for pain control in first trimester surgical abortion
Regina-Maria Renner1, Madeleine Ennis1, Adrienne E McKercher1
1Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
The Cochrane Database of Systematic Reviews
|February 13, 2024
Summary
A 20 mL 1% plain lidocaine paracervical block (PCB) effectively reduces pain during early surgical abortions. Evidence supports foregoing buffering lidocaine and waiting periods, with shallower and fewer injection sites proving sufficient for pain management.
Area of Science:
- Gynecology
- Anesthesiology
- Pain Management
Background:
- Surgical abortion before 14 weeks gestation is a common procedure.
- Many individuals experience pain despite available pain control methods.
Approach:
- Systematic review and meta-analysis of randomized controlled trials.
- Evaluated local anesthesia for pain control during surgical abortion.
- Assessed outcomes including intraoperative pain, patient satisfaction, and adverse events.
Key Points:
- A 20 mL 1% plain lidocaine paracervical block (PCB) significantly reduced pain during dilation and aspiration compared to a sham PCB (high-certainty evidence).
- Buffering lidocaine, waiting periods, deeper injections (3cm vs 1.5cm), and four-site injections did not offer significant pain reduction benefits over alternatives.
- Topical cervical anesthesia showed inconsistent results and is not routinely supported, though it offered similar pain control to PCB in some comparisons.
Conclusions:
- A 20 mL 1% plain lidocaine PCB is effective for managing pain during early surgical abortions.
- Optimized PCB techniques, including avoiding buffering, waiting times, and using fewer/shallower injections, are supported by evidence.
- Combination therapy with conscious sedation, PCB, and NSAIDs is recommended where available for enhanced pain relief.
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