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Paracervical Block

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

[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

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

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

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

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

84. Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy. (PubMed)

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

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2009 Indian journal of medical sciences Controlled trial quality: uncertain

85. Pain relief for women undergoing oocyte retrieval for assisted reproduction. (PubMed)

) or airway obstruction (OR 0.14, 95% CI 0.02 to 1.22, one RCT, 58 women). Fewer women needed mask ventilation in the CSA group (OR 0.05, 95% CI 0.01 to 0.20, one RCT, 58 women).Evidence was also insufficient to show whether groups differed in satisfaction rates (OR 0.66, 95% CI 0.11 to 4.04, two RCTs, 108 women, I2 = 34%; very low-quality evidence).Trialists provided no usable data for outcomes of interest.2. CSA + paracervical block (PCB) versus other interventions.CSA + PCB versus electroacupuncture (...) in providing effective conscious sedation and analgesia for pain relief during and after oocyte retrieval. Simultaneous use of sedation combined with analgesia such as the opiates, further enhanced by paracervical block or acupuncture techniques, resulted in better pain relief than occurred with one modality alone. Evidence was insufficient to show conclusively whether any of the interventions influenced pregnancy rates. All techniques reviewed were associated with a high degree of patient satisfaction

2018 Cochrane

86. Intrapartum fetal surveillance

–A) less than 0.4 MoM) associated with an increased risk of poor perinatal outcomes (e.g. stillbirth, infant death, FGR, preterm birth and preeclampsia in a chromosomally normal fetus 15 ) · Vasa praevia Intrapartum 2 · Induction of labour with Prostaglandin · Abnormal auscultation or CTG · Oxytocin induction/augmentation · Regional analgesia (epidural or spinal) and paracervical block · Abnormal vaginal bleeding in labour · Maternal pyrexia (greater than or equal to 38 o C) · Meconium or blood stained (...) or more of the following antenatal or intrapartum indications are present in labour, CEFM is recommended 2 because of the synergistic effect on the woman: · 41 to 41 + 6 weeks gestation · Gestational hypertension · Gestational Diabetes Mellitus (GDM) without complicating factors · Obesity (BMI 30–40 kg/m 2 ) · Maternal age greater than or equal to 40 and less than 42 years · Maternal pyrexia (temperature 37.8 o C or 37.9 o C) · Prior to epidural block to establish baseline features 2 3 Fetal heart

2019 Queensland Health

87. 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

88. 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

89. Perioperative Pathways: Enhanced Recovery After Surgery

statistically significant differences in mean postoperative pain scores ( ). The strategy of postoperative minimization of opioid use reduces nausea and vomiting, impairment of bowel function, delayed mobilization, and pulmonary morbidity ( ). Regimens designed to minimize postoperative opioid use also may include the use of scheduled acetaminophen, gabapentin, and nonsteroidal antiinflammatory drugs. For vaginal hysterectomy, paracervical nerve blocks or intrathecal morphine may be useful. For open general (...) hysterectomy ( ). Intraoperatively, epidural and spinal anesthesia strategies, when compared with general anesthesia, decrease overall mortality and postoperative complications, including VTE, blood loss, pneumonia and respiratory depression, myocardial infection, and renal failure ( ), although such strategies limit mobilization. However, epidural and spinal anesthesia strategies are not feasible or appropriate for all surgical procedures. The transversus abdominis plane block (commonly referred

2018 American College of Obstetricians and Gynecologists

90. 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

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

92. Interventions for pain with intrauterine device insertion. (PubMed)

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.

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2015 Cochrane

93. Pain relief in hysterosalpingography. (PubMed)

-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

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2015 Cochrane

94. Nitrous Oxide Compared With Intravenous Sedation for Second-Trimester Abortion: A Randomized Controlled Trial

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

95. Paracervical local anaesthesia for cervical dilatation and uterine intervention. (PubMed)

in the 17 included studies. Some studies reported that women experienced severe pain (mean scores of 7 to 9 out of 10) during uterine intervention, irrespective of the analgesic technique used. We concluded that the available evidence fails to show whether paracervical block is inferior, equivalent or superior to alternative analgesic techniques, in terms of efficacy and safety, for women undergoing uterine interventions. (...) Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cervical dilatation and uterine intervention can be performed under sedation, local or general anaesthesia for obstetrics and gynaecological conditions. Many gynaecologists use paracervical local anaesthesia (PLA) but its effectiveness is unclear.To determine the effectiveness and safety of paracervical anaesthesia for cervical dilatation and uterine intervention when compared with no treatment, placebo, other

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2009 Cochrane database of systematic reviews (Online)

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

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

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

, 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

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

(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

99. 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

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

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

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