Paracervical Block for : A Randomized Controlled TrialLaminaria: A Randomized Controlled Trial Insertion Before Second-Trimester Abortion: A Randomized Controlled Trial

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Abstract

OBJECTIVE:

To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion.

METHODS:

In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm.

RESULTS:

From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2–39] compared with 54 mm [interquartile range 27–61], P=.01, 95% CI −47.0 to −4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78–100] compared with 70 mm [interquartile range 44–90], P=.05, 95% CI 0.0–37.0).

CONCLUSION:

Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02454296.

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