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Paracervical Block

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181. Sacro-lumbar intersegmental spinal reflex in autonomic pathways mediating female sexual function. Full Text available with Trip Pro

intersegmental spinal circuit to midlumbar levels in addition to the sacral spinal circuit. These CAPs in hypogastric nerves were enhanced by bicuculline (10 µM), blocked by tetrodotoxin (1 µM) but were not affected by hexamethonium (200 µM). Retrograde axonal tracing revealed four groups of sensory neurons in S3 dorsal root ganglia that were distinguished immunohistochemically. Midlumbar preganglionic neurons projecting to paracervical ganglia regulating blood flow and motility in the female reproductive (...) Sacro-lumbar intersegmental spinal reflex in autonomic pathways mediating female sexual function. Autonomic neurons in paracervical ganglia mediating vasodilation in the female reproductive tract receive inputs from both midlumbar and sacral spinal levels. However, it is not known how the lumbar pathways are activated.This study tested whether stimulation of pudendal sensory nerve could activate lumbar spinal outflows to paracervical ganglia via a spinal reflex pathway.Isolated spinal cords

2011 Journal Of Sexual Medicine

182. Comparison of level of pain between using manual vacuum aspiration and sharp curettage in management of abnormal uterine bleeding. (Abstract)

Comparison of level of pain between using manual vacuum aspiration and sharp curettage in management of abnormal uterine bleeding. To compare the level of pain between using manual vacuum aspiration and sharp curettage in the patients who had abnormal uterine bleeding that underwent uterine curettage under paracervical block with analgesics.Randomized controlled trial study.Between September 2009 to June 2010, 48 women with abnormal uterine bleeding who need to undergone uterine curettage were

2011 Journal of the Medical Association of Thailand = Chotmaihet thangphaet Controlled trial quality: uncertain

183. Manual vacuum aspiration: a safe and cost-effective substitute of electric vacuum aspiration for the surgical management of early pregnancy loss. (Abstract)

. Majority of EVA were performed under general anaesthesia (95.7%) while majority of MVA were performed under paracervical block (60.3%). Complete evacuation was achieved in 89.6% with MVA vs 91.4% with EVA (p=0.691). MVA was superior in terms of significantly less blood loss (62.08 +/- 32.19 vs 75.71 +/- 35.53; p=0.008), shorter hospital stay (12.26 hours +/- 6.97 vs 19.54 hours +/- 7.95; p=0.000) and less hospital cost (Rs 1419.5 +/- 1337.620 vs Rs. 3222.5 +/- 1816.02; p=0.000). Post-operative pain

2011 JPMA. The Journal of the Pakistan Medical Association Controlled trial quality: uncertain

184. Dilation and evacuation

paracervical block or regional anesthesia may be used. It may be performed with or without ultrasound guidance. Performance under ultrasound guidance has greatly improved our understanding about what actually occurs during a D&E. Prior to the procedure, the cervix is usually softened and passively dilated using osmotic dilators and/or misoprostol. This facilitates cervical dilation during the procedure without injury to the cervix. The first step in the procedure itself is dilation of the cervix

2012 Wikipedia

185. The Impact of Anesthesia on the Absorption of Glycine in Operative Hysteroscopy: a Randomized Controlled Trial

pressure within 20% of preoperative normal and, if needed, ephedrine can be used for this purpose. Patients are ventilated in a normocapnic range with a positive end-expiratory pressure of 3 to 5 mmHg. Other Names: Midazolam Sufentanil Propofol Rocuronium Sevoflurane Ephedrine Active Comparator: Local anesthesia with sedation Procedure: Local anesthesia with sedation For women in the local anesthesia group a paracervical block is performed by the gynecologist using a total of 20 mL of 1% lidocaine (...) intracervically at 2, 4, 7 and 10 o'clock positions and in the area of uterosacral ligaments. Once the block completed, the surgeon waits at least five minutes before performing cervical dilatation to allow for sufficient analgesia. Intravenous sedation consists of midazolam, sufentanil and propofol administered by the anesthesiologist in sufficient doses to maintain a spontaneous ventilation with a Ramsay score < 4. Other Names: Lidocaine Midazolam Sufentanil Propofol Outcome Measures Go to Primary Outcome

2010 Clinical Trials

186. [Effect of transcutaneous electrical acupoint stimulation on BIS and VAS in artificial abortion operation]. (Abstract)

with TEAS on Neiguan (PC 6) and Taichong (LR 3), in group B with paracervical block anesthesia (BA), and in group c with both TEAS and BA. Continuous monitoring of the mean arterial blood pressure (MAP), heart rate (HR), oxygen saturation and bispectral index (BIS) of the patients lasted to 30 min after the operation. The BIS, Visual Analogue Scale (VAS) during the operation and the adverse reactions after the operation were analyzed.After 15 minutes TEAS, the BIS in group A and C were decreased

2010 Zhongguo zhen jiu = Chinese acupuncture & moxibustion Controlled trial quality: uncertain

187. Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. (Abstract)

Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. 19888053 2009 12 02 2013 11 21 0029-7844 114 4 2009 Oct Obstetrics and gynecology Obstet Gynecol Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. 927-8; author reply 928 10.1097/AOG.0b013e3181ba05ba Yu Hai H Yang Xiao-Yun XY eng Comment Letter United States Obstet Gynecol 0401101 0029-7844 0 Anesthetics, Local 98PI200987 Lidocaine (...) UF599785JZ Fentanyl AIM IM Obstet Gynecol. 2009 May;113(5):1052-7 19384120 Anesthetics, Local administration & dosage Autonomic Nerve Block Conscious Sedation Drug Therapy, Combination Female Fentanyl Humans Lidocaine administration & dosage Pregnancy Pregnancy Trimester, First Research Design Vacuum Curettage 2009 11 6 6 0 2009 11 6 6 0 2009 12 16 6 0 ppublish 19888053 10.1097/AOG.0b013e3181ba05ba 00006250-200910000-00033

2009 Obstetrics and Gynecology Controlled trial quality: predicted high

188. [Comparative study of midazolam with ketamine S(+) versus midazolam with uterine paracervical block for manual intrauterine aspiration.]. (Abstract)

[Comparative study of midazolam with ketamine S(+) versus midazolam with uterine paracervical block for manual intrauterine aspiration.]. The aim of this study was to evaluate the efficacy, postoperative analgesia, the degree of satisfaction of the patients submitted to manual intrauterine aspiration, and whether the patient would recommend the technique, by comparing two anesthetic techniques.A prospective study was done with 80 patients divided, randomized, in two groups. All of them received (...) IV midazolam. Afterwards, the MC Group received IV Ketamaine S(+) and the MP Group underwent paracervical uterine block. In the operating room, the efficacy of the technique was evaluated by 3 observers (the researcher, the obstetrician, and the obstetrics resident) and, after one hour, an observer, who did not know which technique had been used, evaluated the postoperative analgesia, and the degree of satisfaction and whether or not the patient would recommend the technique, using a verbal

2009 Revista brasileira de anestesiologia Controlled trial quality: uncertain

189. A comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: a randomised controlled trial. (Abstract)

A comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: a randomised controlled trial. Epidural and spinal analgesia may be contraindicated or unavailable in labour. This randomised controlled study examined the suitability of paracervical block as an alternative method of labour analgesia.Multiparous women in labour were randomised to receive either paracervical block or single-shot spinal analgesia. Pain was quantified using a numerical rating (...) 1.9-3.5; P(g)<0.001). Parturients receiving paracervical block received subsequent analgesia more often (23/56 vs. 3/48, P<0.001). Progress of labour, instrumental delivery rates, detected abnormal decelerations in cardiotocography and neonatal outcome were similar between groups. Shivering (P<0.04) and pruritus (P<0.001) were more common with single-shot spinal analgesia. Parturients in the paracervical block group were less satisfied (median 7.0, IQR 3.0-8.0 vs. median 9.0, IQR 8.0-10.0; P<0.001

2009 International journal of obstetric anesthesia Controlled trial quality: uncertain

190. Comparison of lidocaine 1% and normal saline in paracervical anesthesia for decreasing of pain in curettage. (Abstract)

(third time point), lidocaine 1% is more effective than normal saline. Nerve capsule distention is not the only factor for pain control in paracervical block and analgesic agent is still an important factor. (...) Comparison of lidocaine 1% and normal saline in paracervical anesthesia for decreasing of pain in curettage. The objective of this study was to compare the efficiency oflidocaine with that of plain saline for paracervical pain relief during fractional curettage. The double-blind randomized clinical trial was performed on 150 patients presenting from 2004 to 2005 for curettage. The patients were assigned randomly in two groups to receive lidocaine 1% or normal saline. Number of patients at each

2009 Pakistan journal of biological sciences: PJBS Controlled trial quality: uncertain

191. Impact of paracervical block on postabortion pain in patients undergoing abortion under general anesthesia. (Abstract)

Impact of paracervical block on postabortion pain in patients undergoing abortion under general anesthesia. Paracervical block is used as a way to decrease postoperative pain in patients having abortions under general anesthesia. To date, no studies have evaluated the efficacy of this practice.Patients were recruited from a university-based family planning clinic. Seventy-two patients seeking abortion under general anesthesia were enrolled into the single-blinded study. Thirty-nine patients (...) were randomized to receive a paracervical block, and 33 were randomized to no local anesthesia. The patients completed a demographic survey and visual analog pain scales for pain prior to and at several time points after the procedure. Data regarding the need for additional pain medications postoperatively were recorded. Analysis of variance single factor and two-sample one-sided t test were used in data analysis.Experimental and control groups were similar in all measured demographic

2009 Contraception Controlled trial quality: uncertain

192. Endometrial ablation with paracervical block. (Abstract)

Endometrial ablation with paracervical block. To evaluate the safety, feasibility and efficacy of endometrial ablation under local anesthesia.A prospective cohort study was performed at the gynecology department of a large teaching hospital. Women with dysfunctional uterine bleeding were included to undergo NovaSure endometrial ablation with paracervical block. We measured the acceptability, pain score (visual analog score scale), amenorrhea, and patients' satisfaction after the procedure.We

2009 Journal of Reproductive Medicine

193. Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial. (Abstract)

ibuprofen and a 20-mL paracervical block with 1% lidocaine. The primary outcome was intraoperative pain as measured on a 21-point verbal rating scale that had a range from 0 to 100 (0=no pain and 100=worst pain ever) with an equivalence margin for the treatment group comparison of +/-10.Of 130 women, 65 were randomly assigned to oral sedation and 65 to intravenous sedation. The groups differed at baseline by age and preoperative ratings of depression, stress, and anxiety; however, when adjusted

2009 Obstetrics and Gynecology Controlled trial quality: predicted high

194. Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy. Full Text available with Trip Pro

Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy. Office hysteroscopy with endometrial biopsy is usually the first investigation for abnormal uterine bleeding and other uterine diseases.To evaluate the effect of oral drotaverine with mefenamic acid on pain perception during hysteroscopy and endometrial biopsy and to compare it with that of paracervical block using 1 (...) % lignocaine and with that of intravenous sedation using diazepam with pentazocine.Outpatient gynecological department and open randomized trial.One hundred twenty women undergoing hysteroscopy and endometrial biopsy were randomized into 3 groups. Group I received tablet containing drotaverine hydrochloride (80 mg)+mefenamic acid (250 mg), group II received lignocaine paracervically and group III received intravenous diazepam. The intensity of pain during the procedure, 30 and 60 minutes later on visual

2009 Indian journal of medical sciences Controlled trial quality: uncertain

195. Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. (Abstract)

, and with curettage using a 10-cm visual analog scale (VAS). Assuming a minimal clinically important difference in pain score of 1.6 cm and a mean pain score (+/-standard deviation [SD]) of 4.7 (+/-2.9) cm for paracervical block, 120 patients would provide 80% power with an alpha of .05.For the 132 women randomly assigned, no significant differences in VAS scores (mean+/-SD) were observed between paracervical and intracervical blocks during dilation (2.6+/-2.3 compared with 2.8+/-2.2, P=.72) or curettage (3.9 (...) Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. To estimate the efficacy of paracervical compared with intracervical administration of local anesthesia during first-trimester suction curettage.A double-blind, randomized controlled trial comparing paracervical with intracervical lidocaine was performed in women undergoing elective first-trimester suction curettage with conscious sedation. Pain was assessed at baseline, with dilation

2009 Obstetrics and Gynecology Controlled trial quality: predicted high

196. Conscious sedation and analgesia for oocyte retrieval during in vitro fertilisation procedures. (Abstract)

the studies was not attempted. Of the three trials which compared the effect of conventional medical analgesia plus paracervical block versus electro-acupuncture plus paracervical block, there was no significant difference in clinical pregnancy rates per woman in the two groups (OR 1.01; 95% CI 0.73 to 1.4). For intra-operative pain score as measured by visual analogue scale (VAS), there was a significant difference (WMD -4.95; 95% CI -7.84 to -2.07), favouring conventional medical analgesia plus (...) paracervical block . There was also a significant difference in intra-operative pain by VAS between patient-controlled sedation and physician-administered sedation (WMD 5.98; 95% CI 1.63 to 10.33), favouring physician -administered sedation. However, as different types and dosages of sedative and analgesic agents were used in these trials, these data should be interpreted with caution. For the rest of the trials, a descriptive summary of the outcomes was presented.There is insufficient evidence

2005 Cochrane

197. Parenteral opioids for labor pain relief: a systematic review

was by intravenous, intramuscular and patient-controlled methods. Epidural analgesia and active and placebo paracervical block were also included. The co-drugs included diazepam, lorazepam, promethazine, metoclopramide and placebo. Participants included in the review Other than women in labour, the inclusion criteria were not defined a priori in terms of the participants. Outcomes assessed in the review The primary outcomes were the mother's dissatisfaction with pain relief 1 or 2 hours after administration (...) relief for epidural, compared with intravenous butorphanol, pethidine and fentanyl. There was significant heterogeneity (p<0.0014) among the studies for the duration of first and second stages of labour and rates of oxytocin augmentation. Labour-related outcomes favoured opioids. The neonatal outcomes were similar between the treatment groups. Intramuscular pethidine versus paracervical block (1 double-blind RCT involving 117 women). There was a significant difference in pain relief favouring

2002 DARE.

198. Nitrous oxide for relief of labor pain: a systematic review

to that of paracervical block and probably better than that of opioids, but which is limited in comparison with epidural. It is relatively benign. When applied properly, it can provide significant pain relief for at least 50% of the patients. More sophisticated delivery devices may improve its continued use; a suggested technique was described in the article. Research: The author states that the efficacy of more precise timing, to achieve more optimal concentrations at contraction peaks, could be investigated

2002 DARE.

199. Effects of general and locoregional anesthesia on reproductive outcome for in vitro fertilization: a meta-analysis

pethidine and 10 mg diazepam (intravenous mix and drip in 100 mL isotonic saline solution); 5 mL (subcutaneous) 1% lidocaine with 50 to 100 mg pethidine and 25 mg promethazine (intravenous mix and drip in 100 mL 0.9% saline); epidural block, i.e. 12 mL 0.33% bupivacaine; or paracervical block, i.e. 400 mg mepivacaine. Participants included in the review Women undergoing IVF. Outcomes assessed in the review The reproductive outcomes of cleavage and pregnancy rate were assessed. Cleavage rate was defined

2000 DARE.

200. State-of-the-art flexible hysteroscopy for office gynecologic evaluation

on the reliability of the study and the conclusions drawn. Health technology Diagnostic flexible hysteroscopy without anesthesia, cervical dilatation or paracervical block. Type of intervention Primary prevention; diagnosis. Economic study type Cost-effectiveness analysis. Study population Women with either abnormal uterine bleeding, lost intrauterine devices, or abnormal findings on ultrasound or infertility. Setting Hospital (Tertiary outpatient). The economic study was performed in Cleveland, Ohio, USA. Dates

1995 NHS Economic Evaluation Database.

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