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LARC access. Training and continuing education programs should address common misconceptions and review the key safety evidence and benefits of adolescent LARC use.e134 Committee Opinion Adolescents and LARC OBSTETRICS & GYNECOLOGY drugs (NSAIDs), narcotics, anxiolytics, or paracervicalblocks. The most effective method of pain control has not been established yet (42, 43). One study demonstrated that women who received oral naproxen 1 hour before IUD insertion did not have reduced pain with IUD (...) insertion but did have reduced pain after insertion (44). A paracervicalblock using 1% lidocaine was shown to reduce pain scores among nulliparous adolescents and women aged 14–22 years undergoing IUD insertion, although administration of the block did not improve overall satisfaction with insertion (45). Misoprostol women or in nulliparous patients compared with parous women. In a cohort of 1,177 adolescents and women aged 13–24 years, successful IUD placement was achieved on first attempt in 96
of first-trimester abortion: a study of psychosocial and medical predictors. Pain 1989;36:339-50. Glantz JC, Shomento S. Comparison of paracervicalblock techniques during first trimester pregnancy termination. Int J Gynaecol Obstet 2001;72:171-8. Romero I, Turok D, Gilliam M. A randomized trial of tramadol versus ibuprofen as an adjunct to pain control during vacuum aspiration abortion. Contraception 2008;77:56-9. Show all 46 references LinkOut - more resources Full Text Sources Full-text links [x] [x
-0.60, 95% CI -1.56 to 0.36, 1 study, n = 91, low quality evidence). Topical anaesthetics were found to be more effective than paracervicalblock for pain relief during HSG (MD -2.73, 95% CI -3.86 to -1.60, 1 study, n = 20, moderate quality evidence). This benefit did not extend to within 30 minutes following HSG (MD -1.03, 95% CI -2.52 to 0.46, 1 study, n = 20, low quality evidence); or 30 minutes or more after HSG (MD 0.31, 95% CI -0.87 to 1.49, 1 study, n = 20, low quality evidence
for IUC-insertion pain was lower with lidocaine and prilocaine cream (MD -1.96, 95% CI -3.00 to -0.92). Among nulliparous women, topical 4% formulation showed lower scores for IUC-insertion pain assessed within 10 minutes (MD -15.90, 95% CI -22.77 to -9.03) and at 30 minutes later (MD -11.10, 95% CI -19.05 to -3.15). Among parous women, IUC-insertion pain was lower with 10% spray (median 1.00 versus 3.00). Compared with no intervention, pain at tenaculum placement was lower with 1% paracervicalblock (...) (MD -0.98, 95% CI -1.64 to -0.32) after insertion. Most women were nulliparous and also had lidocaine paracervical block.Nearly all trials used modern IUC. Most effectiveness evidence was of moderate quality, having come from single trials. Lidocaine 2% gel, misoprostol, and most NSAIDs did not help reduce pain. Some lidocaine formulations, tramadol, and naproxen had some effect on reducing IUC insertion-related pain in specific groups. The ineffective interventions do not need further research.
Control and Prevention, 2011; Likis, et al., 2012). For women interested in other types of pain relief or in delaying the timing of an epidural, there are several options including inhaled nitrous oxide (N2O, also known as “laughing gas”), other inhaled anesthetic gases, opioids, paracervical or pudendal block, transcutaneous electrical nerve stimulation, hydrotherapy, sterile water injections, and psychoprophylaxis (Likis et al., 2012). Inhaled nitrous oxide is a non-invasive form of pain relief (...) , and 4% used both methods. Other methods used in this study included parenteral opioids, pudendal or regional anesthetic blocks, no pharmacologic pain management, and combinations of these methods. The Swedish cross-sectional study, published in 1996, gathered data on women who had used N2O, epidural, local anesthesia, acupuncture, hydrotherapy, and breathing techniques as their primary pain management technique. About 79% of women used N2O and 34% used epidural (categories were not mutually
359 10.7.1 Peripheral nerve blocks 359 10.7.2 Central neural blockade 361 10.8 Acute pain in children with cancer 365 10.8.1 Cancer-related pain 365 10.8.2 Procedure-related pain 365 10.8.3 Treatment-related pain 366 References 367 Acute Pain Management: Scientific Evidence xvii CONTENTS 11. OTHER SPECIFIC PATIENT GROUPS 385 11.1 The pregnant patient 385 11.1.1 Management of acute pain during pregnancy 385 11.1.2 Management of pain during delivery 390 11.1.3 Pain management during lactation 394
fentanyl (100 micrograms) and midazolam (2 mg). Paracervicalblock was administered to both groups. The primary outcome measure was immediate postabortion recall of maximum pain on a 100-mm visual analog scale.Between August 2016 and March 2017, we assessed 170 women for eligibility and enrolled 39, 19 in the nitrous group and 20 in the IV sedation group. Seven participants in the nitrous group (36.8%) required conversion to IV sedation for inadequate pain control. No participants in the IV sedation
and 349 participants, respectively. The heterogeneity of interventions and outcomes prevented pooled analyses. Medical TOP: women receiving routine or continuous epidural analgesia experienced mild pain. The prophylactic use of nonsteroidal anti-inflammatory drugs (NSAIDs) decreased pain (mean difference -0.5, P < 0.001) and additional opioid requirements (3.5 versus 7 mg, P = 0.04) compared with placebo/other treatment. Paracervicalblock was ineffective. No studies assessed intramuscular (IM (...) )/intravenous (IV) opioid or nonpharmacological treatment. Surgical TOP: general anaesthesia/deep IV sedation alleviated pain. Nitrous oxide was ineffective. No studies assessed moderate IV sedation, IV/IM opioid, paracervicalblock without sedation, NSAID or nonpharmacological treatment.Based on limited data, regional analgesia and NSAIDs mitigated second-trimester medical TOP pain; general anaesthesia/deep IV sedation alleviated surgical TOP pain.Although women experience intense pain during second
, use of misoprostol requires a delay, which may be a barrier to access. For these reasons, routine misoprostol before IUD insertion in nulliparous women is not recommended, although it may be considered with difficult insertions. Nitroprusside before IUD insertion in nulliparous women was also ineffective in decreasing pain or increasing ease of insertion ( ). More research is needed to identify effective options to reduce pain for IUD insertion. Although a paracervicalblock has demonstrated (...) effectiveness in other office-based transcervical procedures, its effectiveness in reducing IUD insertion pain is controversial. Studies of paracervicalblock effectiveness have included nulliparous and parous women. Two randomized studies compared a 10-mL 1% lidocaine paracervicalblock with no local anesthetic or saline injection before IUD insertion among American women who received the Copper T380a and the 5-year levonorgestrel-releasing IUD ( ) and Turkish women who received the Copper T380a ( ). Both
; IOL Induction of labour; MoM Multiples of Median; PaPP-A Pregnancy associated plasma protein-A; PROM Premature Rupture of Membranes; PTL Preterm labour; PV Per Vaginal; T Temperature; = greater than or equal to; < Less than; = Equal to; o C Degrees Celsius Intrapartum • IOL with Prostaglandin • Abnormal auscultation or CTG • Oxytocin induction/augmentation • Post PV Prostaglandins at onset of contractions • Regional analgesia/paracervicalblock (obtain baseline trace prior to insertion) • Abnormal
. Althoughthepaincontrolusedduringtheprocedurewasnot controlled and could have induced a paracervicalblock, nitrous oxide, fentanyl and/or midazolam, the average pain score 1 h after the procedure was 2.24 in the misoprostol group and 0.78 in the laminaria group (pb.001). This difference held after multivariable analysis with moderate to severe pain occurring postoperatively in 24% of the misoprostol group and 4.5% in the laminaria group. The authorsspeculatethatcontinuinguterinecontractionscaused by the misoprostol contributed
functions. Procedures involving the endocervical canal, such as insertion of an endocervical speculum or curette, may stimulate these nerves and cause a vasovagal reaction, characterized by sweating, slow heart rate, low blood pressure and fainting. A paracervicalblock, to produce local anaesthesia for certain procedures, is performed by injecting anaesthetic at various points in the body of the ectocervix or the vaginal fornices, but avoiding inserting the needle at 3 and 9 o’clock, where vessels (...) sides along the length of the cervix. It is important to keep the vessel location in mind to avoid injecting local anaesthetic into a vessel when applying cervical anaesthesia. The lymph nodes and ducts draining the pelvic organs lie close to the blood vessels and may act as a pathway for the spread of cervical cancer. In late stages of cancer, large tumours may block lymphatic drainage and cause the legs to swell (lymphoedema). g. Nervous system of the pelvic region The ectocervix has no pain nerve
technique or drug which would improve this pregnancy rate should be recommended. Conscious sedation and general anesthesia proved to be well tolerated for woman and the oocytes, despite the use of propofol, opioids, benzodiacepines, nitrous oxide, or other drugs. Spinal anesthesia and paracervicalblock are also acceptable options, and can be combined with conscious sedation. Nevertheless, more studies are needed to find out the ideal drug or technique combination for the woman and the oocyte.
of opioids after the procedure was not standardized among patients, 73% of women received a short-term prescription for oxycodone. A lower percentage of women in the gabapentin group self-reported taking opioids in the 24 hours postprocedure (18% vs 47%; odds ratio 0.26; 95% CI 0.09-0.75).The addition of gabapentin to usual oral pain management regimens with paracervicalblock did not reduce postoperative pain for patients undergoing outpatient surgical abortion. Although the addition of gabapentin
), in addition to the paracervicalblock and conscious sedation. The primary outcome is pain levels of women during the retrieval assessed by the visual analog scale. Secondary outcomes include satisfaction of women and postoperative side effects.TENS is an effective non-pharmacological and non-invasive method for pain relief in a number of clinical conditions. Both women and assisted conception unit can benefit if the addition of non-invasive, simple, and low-cost TENS application is proven to be superior (...) than using conscious sedation and paracervicalblock alone.ClinicalTrials.gov, NCT03472430 . Registered on 3 May 2018.
of a lidocaine versus sham paracervical nerve block for pain control during levonorgestrel 13.5 mg IUD insertion. Adolescent and young adult women ages 14 to 22 years were recruited from three outpatient academic sites in Philadelphia, PA.Pain scores were recorded at seven steps during the procedure from speculum insertion through removal. Time stamps associated with each step were used to calculate the overall procedure duration. Cumulative IUD insertion procedure duration was estimated using the Kaplan