Intraoperative blood loss in midtrimester dilatation and extraction

Intraoperative blood loss was evaluated in 215 patients undergoing a midtrimester dilatation and extraction procedure using a paracervical-intracervical block. Patients were assigned to four randomized drug regimens using a combination of 0.5% bupivacaine, dilute epinephrine, and methylergonovine maleate. From these four regimens, a select group of patients were given fentanyl. No significant difference in blood loss was observed in any group at less than 17 weeks' gestation. Only in gestations of 17 weeks or more was there a significant increase in blood loss, and this increase was associated specifically with the use of fentanyl in the nonrandomized selected group.