Assessing the effect of paracervical block volume on pain control for dilation and curettage: A randomized controlled trial
Awarded 2018
Complex Family Planning Fellowship Research
Bonnie Crouthamel, MD
University of California, San Diego

This is a double center, randomized, 2 arm (1:1), single blinded clinical trial comparing pain control at the time of uterine aspiration with two different paracervical blocks in women undergoing dilation and curretage in the first trimester for either surgical abortion or miscarriage management. The primary aim is to compaire on a visual analog scale (VAS) pain at the time of cervical dilation using a paracervical block containing 40cc buffered 0.5% lidocaine with 2U Vasopressin compared to a block containing 20cc buffered 1% lidocaine with 2U Vasopressin.  Women < 12 weeks gestation presenting to UCSD and UCLA Family Planning Clinics who desire surgical termination of pregnancy in the clinic setting and women diagnosed with a missed abortion < 12 weeks gestation who desire surgical management in the clinic setting will be included in the study.  Participants will be randomized to receive one of the two types of paracervical blocks. Prior to the procedure, the patient will answer a questionnaire detailing her age, race, obstetric history and history of cervical procedures.  The dilation and curretage will be performed by the physician in the usual fashion using the designated paracervical block.  The study coordinator, who will be blinded to the type of paracervical block, will ask the participant to detail her pain level using a VAS at baseline, speculum insertion, paracervical block placement, cervical dilation, immediately after uterine aspiration, 10 minutes post-procedure, and overall pain.  The participant will also be asked about side effects of lightheadedness, tinnitus, circumoral tingling, and a metallic taste in the mouth immediately after paracervical block placement. After the procedure, the physician will answer a questionnaire providing specific details of the procedure and adverse events.