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Paracervical Block

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101. Gabapentin for Perioperative Pain Management for Uterine Aspiration: A Randomized Controlled Trial. (PubMed)

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

102. Reducing Pain During Intrauterine Device Insertion: A Randomized Controlled Trial in Adolescents and Young Women

Reducing Pain During Intrauterine Device Insertion: A Randomized Controlled Trial in Adolescents and Young Women To estimate the effect of a 1% lidocaine paracervical nerve block on pain during intrauterine device (IUD) insertion compared with a sham block in adolescents and young women.We conducted a multisite, single-blind, sham-controlled randomized trial in adolescents and young women having a 13.5-mg levonorgestrel IUD inserted. Enrollment occurred at three family planning clinics (...) in Philadelphia, Pennsylvania. Eligible adolescents and young women were aged 14-22 years, nulliparous, not currently or recently pregnant, and English-speaking. Participants were randomized using computer-generated allocation in block sizes of four to receive a 10-mL 1% lidocaine paracervical block or a sham block (1 cm depression of the vaginal epithelium at paracervical block sites with a wooden cotton-tipped applicator). Only patients were blinded. The primary outcome was pain after IUD insertion measured

2017 EvidenceUpdates

103. 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

105. 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

106. 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

107. Randomized double-blind clinical trial comparing two anesthetic techniques for ultrasound-guided transvaginal follicular puncture. (PubMed)

Randomized double-blind clinical trial comparing two anesthetic techniques for ultrasound-guided transvaginal follicular puncture. To compare the anesthetic techniques using propofol and fentanyl versus midazolam and remifentanil associated with a paracervical block with lidocaine in performing ultrasound-guided transvaginal oocyte aspiration.A randomized double-blind clinical trial (#RBR-8kqqxh) performed in 61 women submitted to assisted reproductive treatment. The patients were divided (...) into two groups: anesthetic induction with 1mcg/kg of fentanyl associated with 1.5mg/kg of propofol (FP Group, n=32), in comparison with anesthetic induction using 0.075mg/kg of midazolam associated with 0.25mcg/kg/min of remifentanil, and paracervical block with 3mL of 2% lidocaine (MRPB Group, n=29). Main outcome measures: human reproduction outcomes, modified Aldrete-Kroulik index, hemodynamic parameters, and salivary cortisol.The results revealed a higher number of embryos formed in the FP Group

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2016 Einstein (Sao Paulo, Brazil) Controlled trial quality: uncertain

108. Anaesthesia for evacuation of incomplete miscarriage. (PubMed)

-RCTs comparing the use of any anaesthetic technique (defined by authors as general anaesthesia, sedation/analgesia, regional or paracervical local block (PCB) procedures) to perform surgical evacuation of an incomplete miscarriage. We excluded quasi-randomised trials and studies that were only available as abstracts.Two review authors independently assessed studies for inclusion and assessed risk of bias. Data were independently extracted and checked for accuracy.We included seven trials involving (...) Anaesthesia for evacuation of incomplete miscarriage. An incomplete miscarriage occurs when all the products of conception are not expelled through the cervix. Curettage or vacuum aspiration have been used to remove retained tissues. The anaesthetic techniques used to facilitate this procedure have not been systematically evaluated in order to determine which provide better outcomes to the patients.To assess the effects of general anaesthesia, sedation or analgesia, regional or paracervical

2012 Cochrane

109. Pain Management for First-Trimester Uterine Aspiration. (PubMed)

. Preoperative, procedural, and postoperative pain control are all reviewed.Authors searched the online database PubMed for relevant published literature through January 2018. To identify possible publications for review, the key word "abortion" was paired with the following key words: "pain," "pain-control," "pain management," "aspiration," "paracervical block," "sedation, "non-pharmacologic," and "post-operative."Optimizing pain control for first-trimester uterine aspiration may involve interventions (...) before, during, and after the surgery. Evidence shows patients benefit from premedication with nonsteroidal anti-inflammatory drugs, a defined paracervical block technique, and an option to use one of several nonpharmacologic interventions.Pain management for first-trimester uterine aspiration should be individualized for optimal patient satisfaction. Evidence supports multiple approaches to support this individualization. Targeted interventions before, during, and after the procedure should

2018 Obstetrical & Gynecological Survey

110. TENS for Suction Evacuation for Termination of 1st Trimester Pregnancies

: Placebo Transcutaneous nerve stimulation (TENS) Not Applicable Detailed Description: Suction evacuation is a minor gynecological procedure commonly performed at an outpatient setting for termination of pregnancy. Although it is a simple surgical procedure lasting 5-10 min and can be done under various methods of pain control, 78-97% of women still report at least moderate procedural pain, especially during injection of paracervical block, cervical dilation, suction aspiration and postoperatively

2018 Clinical Trials

111. Factors affecting pain during outpatient clinic based surgical procedures in gynecologic oncology. (PubMed)

the severity of pain experienced during punch biopsy and ECC in an outpatient clinic of gynecologic oncology department.In this retrospective, exploratory study, a total of 101 Korean patients with abnormal cervical cytology underwent punch biopsy and ECC under a paracervical block performed for pain relief. Residents under training performed these procedures and recorded patient-reporting maximum Numeric Rating Scale (NRS) scores experienced during the procedures. Residents were classified into four

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2018 Medicine

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

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 Obstetrics and Gynecology Controlled trial quality: predicted high

113. Different analgesics prior to intrauterine device insertion: is there any evidence of efficacy? (PubMed)

of the following medications prior to IUD insertion: 10 ml 1% lidocaine paracervical block, 400 μg oral misoprostol, oral naproxen or placebo tablets. The primary outcome measure was the level of pain experienced at different steps of IUD insertion and 15 min after the procedure, measured by a visual analogue scale (VAS).Between July 2015 and March 2016, 208 women were invited to participate in the study: eight refused and the remaining 200 women were randomised equally into four treatment groups (50

2018 The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception Controlled trial quality: predicted high

114. Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. (PubMed)

Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. To assess pain-management using auricular acupuncture as an adjunct to ibuprofen and paracervical block during first trimester uterine aspiration, and to assess auricular acupuncture's effect on anxiety.This randomized, double-blinded, three-arm trial enrolled women undergoing uterine aspiration for spontaneous or induced abortion. Study participants were (...) randomized 1:1:1 to receive auricular acupuncture, placebo, or usual care alone. Participants in all groups received ibuprofen and paracervical block (usual care). The main outcome was maximum pain reported at the end of the procedure measured using a Visual Analog Scale; we compared those receiving auricular acupuncture to those receiving usual care alone. We also compared auricular acupuncture to placebo and placebo to usual care alone. Finally, we compared the maximum anxiety scores between

2018 Contraception Controlled trial quality: predicted high

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

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 Obstetrics and Gynecology Controlled trial quality: predicted high

116. Patient choice of adjunctive non-pharmacologic pain management during first-trimester abortion: a randomized controlled trial. (PubMed)

of nonpharmacologic pain management options (intervention). Standard care was ibuprofen 800 mg orally at least 30 min preprocedure, lidocaine paracervical block and anticipatory guidance from the provider. We measured pain on a 100-mm visual analog scale immediately postprocedure with adequate sample size to detect a 20-mm difference in pain scores.Seventy-four women participated in the trial and reported an overall mean pain score of 61.9±27.0. Participants in the control and intervention groups reported similar

2018 Contraception Controlled trial quality: uncertain

117. Satisfaction With the Intrauterine Device Insertion Procedure Among Adolescent and Young Adult Women. (PubMed)

participants were 14-22 years of age, nulliparous, not pregnant, and English-speaking. Randomization was computer-generated allocation in block sizes of four to a 1% lidocaine paracervical or sham block. Only patients were blinded. Satisfaction was measured with three items that assessed overall satisfaction with the procedure, whether participants would recommend the IUD to a friend, and the perception that the IUD was worth the discomfort. Predictors included demographics, sexual and reproductive history

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2018 Obstetrics and Gynecology Controlled trial quality: predicted high

118. Self-administered lidocaine gel for local anesthesia prior to osmotic dilator placement: a randomized trial. (PubMed)

Self-administered lidocaine gel for local anesthesia prior to osmotic dilator placement: a randomized trial. To compare pain scores during cervical dilator placement prior to dilation and evacuation (D&E) with patient-administered vaginal lidocaine gel versus lidocaine paracervical block (PCB).We conducted an unblinded randomized trial of women ≥18 years of age undergoing surgical abortion at ≥16 weeks' gestation in two outpatient clinics. We randomized participants to receive self-administered (...) &E is noninferior to paracervical lidocaine block for local anesthesia and is a potential alternative to PCB for pain management with osmotic dilator placement.Lidocaine gel and similar products represent noninvasive, nonpainful methods of local anesthesia for a variety of outpatient gynecologic procedures. Given our noninferiority findings, if gel anesthetics are available, they should be considered as an alternative to paracervical block.Copyright © 2018 Elsevier Inc. All rights reserved.

2018 Contraception Controlled trial quality: predicted high

119. Self-Administered Lidocaine Gel for Pain Control With First-Trimester Surgical Abortion: A Randomized Controlled Trial (PubMed)

as measured on a 100-mm visual analog scale. A sample size of 142 participants was planned to detect a 15-mm or greater difference on the 100-mm visual analog scale with 90% power and a significance level of .025, adding 10% for participant dropout and protocol violations. Participants received either 12 mL of a 1% lidocaine paracervical block or 20 mL of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. Secondary outcomes included anticipated pain, baseline pain, pain (...) with speculum and tenaculum placement, pain after suction aspiration, and pain 30-45 minutes postoperatively.From April to October 2015, a total of 142 women were enrolled (68 in the paracervical block group, 69 in the gel group, and five not analyzed as a result of participant withdrawal). Sociodemographic characteristics were similar between groups. The mean pain score with cervical dilation was 60 mm (95% confidence interval [CI] 54-66) in the paracervical block group and 64 mm (95% CI 59-69) in the gel

2016 EvidenceUpdates Controlled trial quality: predicted high

120. Best Practice in Outpatient Hysteroscopy

diagnostic hysteroscopy. However, it is unclear how clinically significant this reduction in pain is. Consideration should be given to the routine administration of intracervical or paracervical local anaesthetic, particularly in postmenopausal women. © Royal College of Obstetricians and Gynaecologists 3 of 22 RCOG Green-top Guideline No.59 B A A C A A AMiniaturisation of hysteroscopes and increasing use of the vaginoscopic technique may diminish any advantage of intracervical or paracervical (...) anaesthesia. Routine administration of intracervical or paracervical local anaesthetic should be used where larger diameter hysteroscopes are being employed (outer diameter greater than 5mm) and where the need for cervical dilatation is anticipated (e.g. cervical stenosis). Routine administration of intracervical or paracervical local anaesthetic is not indicated to reduce the incidence of vasovagal reactions. Conscious sedation Conscious sedation should not be routinely used in outpatient hysteroscopic

2011 Royal College of Obstetricians and Gynaecologists

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