Patient and provider perspectives on pain management during manual vacuum aspiration

Manual vacuum aspiration (MVA) is a painful procedure often conducted without analgesia. The World Health Organization (WHO) recommends a paracervical block (PCB) as the mode of pain relief during MVA. Few studies have assessed patient perspectives on pain control during MVA. We investigated the perspectives of health workers and patients on MVA under PCB. This study was nested within a pilot randomized controlled trial (RCT) evaluating the Chloe SED (syringe extension device) for PCB provision. Eleven providers and 61 patients were enrolled. All providers had MVA experience. They had not provided pain relief on 20% of occasions, and only one had previously administered PCB for MVA. Both patients and providers indicated MVA was painful and deserving of analgesia. Pain was the most common reason for difficulty completing an MVA. Providers noted that PCB made the procedure more tolerable. For patients, efficacy, remaining conscious, and same-day discharge were key considerations when selecting pain relief. Notably, 84% of patients expressed satisfaction with MVA under PCB. PCB is a vital component of the MVA care package. Considering patient and provider perspectives is essential to optimizing a humane and effective procedural experience.