Refining paracervical block techniques for pain control in first trimester surgical abortion
Awarded 2011
Large Research Grants
Paula Bednarek, MD, MPH
Oregon Health & Science University

Objectives: To compare pain control during cervical dilation between two paracervical block (PCB) techniques among women undergoing first trimester surgical abortion. Our research group established the benefit of a specific PCB technique: 20mL 1% buffered lidocaine (2mL at tenaculum site, 18mL paracervical at 4-sites), with a 3 minute wait prior to cervical dilation (PCB 20/4/3). This beneficial technique has the disadvantage of requiring a 3-minute wait, which sometimes almost doubles the time of the procedure. Additionally, injections can cause pain, so it is possible that 2 injections would be preferable to 4, if the pain control offered was not different. Methods: The 2-phase study randomized women undergoing surgical abortion up to 11 weeks to receive the PCB 20/4/3 with and without a 3-minute wait prior to dilation. Once the results of this phase were known, women were then randomized to receive either 2 or 4 injections for the PCB. Results: Phase 1 showed that waiting 3 minutes was not necessary compared to no wait. Preliminary analysis of Phase 2 data show that 4 injections reduces pain a small amount more than 2 injections for dilation only. The other aspects of the procedure are not different between these two PCB techniques. Conclusion: Given no clinically relevant differences, we recommend the use of a 2-site and no-wait PCB technique.