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Paracervical Block

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81. Pain control in surgical abortion part 1 ? local anesthesia and minimal sedation

surgical abortion. Contraception2008;78:155–61 [Evidence Grade: I]. [17] DonatiS,MeddaE,ProiettiS,RizzoL,SpinelliA,SubriziD,etal.Reducingpainof?rst trimester abortion under local anaesthesia.Eur J Obstet Gynecol ReprodBiol1996; 70:145–9 [Evidence Grade: II-2]. [18] Glantz JC, Shomento S. Comparison of paracervical block techniques during ?rst trimester pregnancy termination. Int J Gynaecol Obstet 2001;72:171–8 [Evidence Grade:I]. [19] Allen RH, Kumar D, Fitzmaurice G, Lifford KL, Goldberg AB. Pain (...) - juncttopaincontrolduringvacuumaspirationabortion.Contraception2008;77:56–9 [EvidenceGrade:I]. [46] Cansino C, Edelman A, Burke A, Jamshidi R. Paracervical block with combined ketorolacandlidocainein?rst-trimestersurgicalabortion:arandomizedcontrolled trial. ObstetGynecol 2009;114:1220–6 [Evidence Grade: I]. [47] Mody SK, Kiley J, Rademaker A, Gawron L, Stika C, Hammond C. Pain control for intrauterine deviceinsertion:a randomizedtrialof1%lidocaine paracervicalblock. Contraception 2012;86:704–9 [Evidence Grade: I]. [48] GoldthwaiteLM,BaldwinMK,PageJ,MicksEA

2018 Society of Family Planning

82. Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices

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 paracervical blocks. 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 paracervical block 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

2018 American College of Obstetricians and Gynecologists

83. Impact of music therapy before first-trimester instrumental termination of pregnancy: a randomised controlled trial

of first-trimester abortion: a study of psychosocial and medical predictors. Pain 1989;36:339-50. Glantz JC, Shomento S. Comparison of paracervical block 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

2020 EvidenceUpdates

84. Pain relief in hysterosalpingography. (Abstract)

-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 paracervical block 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

2015 Cochrane

85. Interventions for pain with intrauterine device insertion. (Abstract)

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% paracervical block (...) (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.

2015 Cochrane

86. Nitrous Oxide Use for Labor Pain Management

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

2016 Oregon Health Evidence Review Commission

87. Acute pain management: scientific evidence (3rd Edition)

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

2015 National Health and Medical Research Council

88. Nitrous Oxide Compared With Intravenous Sedation for Second-Trimester Abortion: A Randomized Controlled Trial (Abstract)

fentanyl (100 micrograms) and midazolam (2 mg). Paracervical block 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

2018 EvidenceUpdates

89. Methods of pain control during endometrial biopsy: A systematic review and meta-analysis of randomized controlled trials. (Abstract)

measures among studies that examined paracervical block and nonsteroidal anti-inflammatory drugs (NSAID) was observed. However, paracervical block and NSAID were associated with significant pain reduction compared to placebo in most of the related studies.Intrauterine anesthetics, anesthetic cervical spray, paracervical block and oral NSAID provide effective pain control during endometrial biopsy.© 2019 Japan Society of Obstetrics and Gynecology.

2020 The journal of obstetrics and gynaecology research

90. Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review. (Full text)

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. Paracervical block 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, paracervical block 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

2020 BJOG : an international journal of obstetrics and gynaecology PubMed abstract

91. Clinical Challenges of Long-Acting Reversible Contraceptive Methods

, 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 paracervical block has demonstrated (...) effectiveness in other office-based transcervical procedures, its effectiveness in reducing IUD insertion pain is controversial. Studies of paracervical block effectiveness have included nulliparous and parous women. Two randomized studies compared a 10-mL 1% lidocaine paracervical block 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

2016 American College of Obstetricians and Gynecologists

93. Flowchart: Intrapartum fetal surveillance , Mode of fetal heart rate monitoring

; 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/paracervical block (obtain baseline trace prior to insertion) • Abnormal

2015 Queensland Health

94. Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation)

. Althoughthepaincontrolusedduringtheprocedurewasnot controlled and could have induced a paracervical block, 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

2015 Society of Family Planning

95. Acute Pain Management: Scientific Evidence

-injection peripheral nerve blocks 211 5.8.2 Periarticular and intra-articular analgesia 216 5.8.3 Wound infiltration including wound catheters 217 5.8.4 Topical application of local anaesthetics 217 5.8.5 Safety 218 5.9 Regional analgesia and concurrent anticoagulant medications 221 5.9.1 Neuraxial block and epidural haematoma 221 5.9.2 Plexus and other peripheral regional block and anticoagulants 223 References 223 6. PATIENT-CONTROLLED ANALGESIA 241 6.1 Efficacy of intravenous PCA 241 6.1.1 Analgesia (...) 441 9.4.8 Corticosteroids 443 9.5 Opioid infusions and PCA 444 9.5.1 Opioid infusions 444 9.5.2 Patient-controlled analgesia 445 9.5.3 Nurse-controlled analgesia 447 9.5.4 PCA by proxy 447 9.5.5 Overall safety of parenteral opioid use in children 448 9.6 Regional analgesia 449 9.6.1 Continuous and single-injection peripheral nerve blocks 449 9.6.2 Neuraxial blocks 453 9.6.3 Topical therapies 464 9.7 Management of procedural pain in children 465 9.7.1 Procedural pain in the neonate 466 9.7.2

2015 Clinical Practice Guidelines Portal

96. Comprehensive cervical cancer control

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 paracervical block, 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

2015 World Health Organisation Guidelines

97. Anesthesia and analgesia for transvaginal oocyte retrieval. Should we recommend or avoid any anesthetic drug or technique? (Abstract)

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 paracervical block 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.

2019 Current Opinion in Anaesthesiology

98. Gabapentin for Perioperative Pain Management for Uterine Aspiration: A Randomized Controlled Trial. (Abstract)

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 paracervical block did not reduce postoperative pain for patients undergoing outpatient surgical abortion. Although the addition of gabapentin

2019 Obstetrics and Gynecology Controlled trial quality: predicted high

99. Randomized controlled trial of transcutaneous electrical nerve stimulation for pain relief during transvaginal oocyte retrieval using conscious sedation: study protocol for a randomized controlled trial. (Full text)

), in addition to the paracervical block 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 paracervical block alone.ClinicalTrials.gov, NCT03472430 . Registered on 3 May 2018.

2019 Trials Controlled trial quality: predicted high PubMed abstract

100. Intrauterine Device Insertion Procedure Duration in Adolescent and Young Adult Women. (Abstract)

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

2019 Journal of pediatric and adolescent gynecology Controlled trial quality: uncertain

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