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Paracervical Block

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121. 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

122. 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

124. Lidocaine for Pain Control During Intrauterine Device Insertion

-200 mg equivalent to 10 ml lidocaine (20 mg/ml) is injected at four and eight o'clock of the cervico-vaginal junction, and 2 ml to the area to be grasped with the tenaculum for paracervical block. Drug: Lidocaine topical Local anesthetic for reduction of IUD associated pain Outcome Measures Go to Primary Outcome Measures : Pain scores assessed by 10-point VAS scale [ Time Frame: 1 year ] VAS scores will be assessed on at three different points; baseline after application of speculum and analgesic

2017 Clinical Trials

125. Non-opioid pain management in benign minimally invasive hysterectomy: A systematic review. (PubMed)

, anticonvulsants and dexamethasone demonstrate opioid-sparing benefits; ketorolac shows mixed results in laparoscopic hysterectomies. Paracervical blocks provide pain-reducing benefits in vaginal hysterectomies.Convincing conclusions are difficult to draw because of the heterogeneous and contradictory nature of the literature. There is a clear need for more high-quality research that will evaluate each medication type for posthysterectomy pain control.Copyright © 2016 Elsevier Inc. All rights reserved.

2017 American Journal of Obstetrics and Gynecology

126. The Effect of Local Anesthesia on Postoperative Pain in Vaginal Hysterectomy

incision, and in a systematic fashion as a modified paracervical block. First, 2 ml will be injected through the vaginal fornices at 03.00, 06.00, 09.00, and 12.00 hours at 2 cm depth. Thus, 8 ml will be systematically injected around the cervical circumference before incision. In addition, 1 ml of the solution will be injected in each resection line (sacro-uterine and cardinal ligaments), adding up to a total of 10 ml. In case of performing additional anterior/ posterior colporrhaphy, additional (...) Comparator: Study Marcaine 0.5 % Injectable Solution will be injected before incision, and in a systematic fashion as a modified paracervical block. First, 2 ml will be injected through the vaginal fornices at 03.00, 06.00, 09.00, and 12.00 hours at 2 cm depth. Thus, 8 ml will be systematically injected around the cervical circumference before incision. In addition, 1 ml of the solution will be injected in each resection line (sacro-uterine and cardinal ligaments), adding up to a total of 10 ml. In case

2017 Clinical Trials

127. 12 Versus 20 mL PCB for D&E Cervical Prep

research is needed to investigate methods of pain control for cervical preparation for abortion procedures. Women report pain with paracervical block injection as well as with osmotic dilator placement. This study seeks to compare a 12 mL, 2-site 1% plain lidocaine paracervical block for pain control during cervical preparation (osmotic dilator insertion) for Dilation and Evacuation (D&E) to a 20 mL 1% lidocaine 2-site paracervical block. Condition or disease Intervention/treatment Phase Pain Other: 12 (...) mL paracervical block Other: 20 mL paracervical block Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 96 participants Allocation: Randomized Intervention Model: Parallel Assignment Intervention Model Description: Participants will be randomized to one of two study arms via computer-generated block randomization using REDCap software. Masking: Single (Participant) Masking Description: The provider and staff

2017 Clinical Trials

128. Acupuncture for Pain Management During Uterine Aspiration

Procedure: 12 mm Plasters Not Applicable Detailed Description: Of the estimated 1.06 million abortions performed in the United States in 2011, approximately 91% occurred before 13 weeks gestation. Most first trimester abortions are performed in an outpatient center with a paracervical block as the only analgesic. Paracervical block is associated with improved pain control during dilation and aspiration however, women still experience moderate to severe pain. Moderate sedation and general anesthesia (...) , minimize pain more than a paracervical block; however increased cost, regulatory constraints, side effects, health risks, and recovery time may limit abortion access. Pain experienced during abortion results from a complex interaction of physical innervation pathways, psychological and social factors. Pain during abortion is also influenced by additional factors such as age, pregnancy history, and self-reported pre-procedure anxiety about abortion. Adequate pain management during suction aspiration

2017 Clinical Trials

129. 24-hour Mifepristone and Buccal Versus Mifepristone and Vaginal Misoprostol for Cervical Preparation for D&E

: Vaginal Misoprostol Drug: Buccal Misoprostol Phase 4 Detailed Description: Standard of care for cervical preparation prior to second trimester surgical abortion has traditionally been a pelvic exam with speculum, a paracervical block with lidocaine, and placement of a number of osmotic dilators through the cervical canal. Dilators obtain maximal expansion within 4-6 hours and patients experience cramping with this process. This cervical preparation allows for a faster procedure for the patient

2017 Clinical Trials

130. Oral Sedation During Cervical Dilator Placement

and Collaborators Johns Hopkins University Society of Family Planning More Information Go to Publications: Soon, R. T., M.; Salcedo. J.; Kaneshiro, B., Paracervical block to decrease pain with second-trimester laminaria insertion: a randomized controlled trial. Contraception 2016, 94 (4), 389. Layout table for additonal information Responsible Party: Johns Hopkins University ClinicalTrials.gov Identifier: Other Study ID Numbers: IRB00117627 First Posted: June 28, 2017 Last Update Posted: June 6, 2018 Last

2017 Clinical Trials

131. IVF oocyte retrieval: prospective evaluation of the type of anesthesia on live birth rate, pain, and patient satisfaction (PubMed)

IVF oocyte retrieval: prospective evaluation of the type of anesthesia on live birth rate, pain, and patient satisfaction Does the type of anesthesia (paracervical block (PCB) or general anesthesia (GA)) impact live birth rate, pain, and patient satisfaction?A non-randomized prospective cohort study was conducted in women treated for IVF. Two groups of patients were prospectively included: the PCB group (n = 234) and the GA group (n = 247). The type of anesthesia was determined by the patients

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2017 Journal of assisted reproduction and genetics

132. Novel anesthetic technique for combined intracavitary and interstitial brachytherapy for cervix cancer in an outpatient setting (PubMed)

, propofol, fentanyl, and oxycodone. Local anesthesia was achieved with 2% lignocaine gel and a paracervical block containing a mixture of 1% ropivacaine, 2% lignocaine, and 1 : 1,000 adrenaline. Ceftriaxone and ondansetron were given prophylactically. Physiologic monitoring was performed throughout and pain scores were recorded using the Numeric Rating Scale. Follow-up was conducted at 8 weeks from the last fraction of brachytherapy. The feasibility and safety endpoints were a post-anesthesia discharge

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2017 Journal of contemporary brachytherapy

133. Reducing Pain During Intrauterine Device Insertion: A Randomized Controlled Trial in Adolescents and Young Women. (PubMed)

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 Obstetrics and Gynecology Controlled trial quality: predicted high

134. Lidocaine and tenoxicam effectiveness for pain relief during Pipelle: Non-randomised double-blind placebo-controlled trial. (PubMed)

biopsy with Pipelle. Intrauterine lidocaine infusion, paracervical block with lidocaine, intravenous tenoxicam or 4ml intravenous normal saline administered prior to biopsy. The main outcome measure was pain intensity immediately afterwards and 30minutes after biopsy, determined by a visual analogue scale score. Number Cruncher Statistical System 2007 was used for statistical analyses.Of the 232 participants, intrauterine lidocaine infusion group had 59(25.4%) patients, 57(24.6%) were controls while (...) paracervical block group and intravenous tenoxicam group each had 58(25%) patients. Both visual analogue scale 0 and 30 scores of the control group were significantly higher than the other three groups (p<0.05). Also, the scores of intravenous tenoxicam group were significantly higher than both intrauterine lidocaine infusion and paracervical block with lidocaine groups (p<0.05 each).Intravenous tenoxicam had a significantly lower effect than intrauterine lidocaine infusion and paracervical block

2017 JPMA. The Journal of the Pakistan Medical Association Controlled trial quality: predicted high

135. A Prospective Randomized Trial Comparing Dexmedetomidine and Midazolam for Conscious Sedation During Oocyte Retrieval in An In Vitro Fertilization Program. (PubMed)

randomized double-blinded comparative study.Fifty-two patients undergoing oocyte retrieval in their first IVF cycle were randomly allocated into two equal groups. The intervention started with giving fentanyl1 mcg/kg intravenous (IV) followed by paracervical block in both groups. Then, subjects in group (D) received dexmedetomidine at a loading dose of 1 μg/kg IV over 10 min followed by 0.5 μg/kg/h infusion until Ramsay Sedation Scale (RSS) reached 3-4. Patients in group (M) received a loading dose

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2017 Anesthesia, essays and researches Controlled trial quality: uncertain

136. Reducing Pain During Intrauterine Device Insertion: A Randomized Controlled Trial in Adolescents and Young Women. (PubMed)

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 Obstetrics and Gynecology Controlled trial quality: predicted high

137. Management of postabortion hemorrhage

? No history of obstetrical hemorrhage Measures for all ? Preoperative hemoglobin or hematocrit (only if history of anemia for first-trimester surgical) ? Ultrasound for gestational age ? Cervical preparation o Dilators if >20 weeks o Misoprostol or dilators if >13 weeks ? Consider vasopressin in paracervical block Moderate risk ? =2 cesarean sections ? Prior cesarean section and previa ? Bleeding disorder ? History of obstetrical hemorrhage not requiring transfusion ? Increasing maternal age ? Gestational (...) in comparison with or in addition to osmotic dilation in the second trimester to evaluatecervicaldilationhavegenerallynotevaluatedblood loss. The few that have done so have found either no difference or a clinically insignificant difference [51,52]. The use of vasopressin in the paracervical block is an intraoperative measure that has been shown to decrease blood loss with D&E [53]. The decreased blood loss associated with vasopressin, demonstrated in a double- blinded, randomized trial, was most pronounced

2013 Society of Family Planning

138. Second-Trimester Abortion

-trimester abortion, including obtaining a thorough medical history and performing a physical examination to identify and manage risk factors for complications, accurately dating pregnancy by ultrasonography, localizing the placenta (especially in women with prior uterine surgery), and assessing preoperative hemoglobin level and blood type. The use of vasopressin in the paracervical block may decrease blood loss from D&E as reported in one randomized controlled trial ( ). For women with medical (...) of vasopressin in the paracervical block may decrease blood loss from D&E. Methylergonovine maleate is an appropriate first-line uterotonic agent unless contraindicated, as in patients with hypertension. Misoprostol is an effective agent in the setting of postabortion hemorrhage, and doses of 800–1,000 micrograms are recommended. If refractory bleeding is thought to be due to atony or lower uterine segment bleeding, a Foley catheter or intrauterine balloon should be inserted to tamponade the endometrial

2013 American College of Obstetricians and Gynecologists

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

placed by an advanced practice clinician ( ). Most women experience some degree of discomfort during IUD insertion. Obstetrician–gynecologists should provide anticipatory guidance regarding pain that may occur during and after insertion. Provision of additional analgesia during IUD insertion should be individualized and may include nonsteroidal antiinflammatory drugs (NSAIDs), narcotics, anxiolytics, or paracervical blocks. The most effective method of pain control has not been established yet (...) ( , ). 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 ( ). 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 ( ). Misoprostol should not be routinely used before IUD insertion because

2012 American College of Obstetricians and Gynecologists

140. First-trimester abortion in women with medical conditions

,DauphineeLA,SinghS,MooreAM.Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception 2006;74(4):334–44 [Evidence Grade: III]. [22] Tsutsumi Y, Mizuno J, Takada S, Morita S. [Paracervical block for dilatationandcurettageinaparturientwithEisenmenger'ssyndrome]. Masui. 59(3):379–382. [Evidence Grade: III] [23] Sitruk-Ware, R.Mifepristone andmisoprostolsequentialregimenside effects, complications and safety. Contraception. 2006. 74(1): p. 48– 55. 24. [Evidence Grade

2012 Society of Family Planning

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