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Paracervical Block

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161. Nitrous Oxide for Pain Management During In-office Transcervical Sterilization

(Essure®) The standard transcervical sterilization procedure is not being evaluated in this study, and will be performed in the same manner in the two study arms. The procedure includes a standardized paracervical block with 1% lidocaine. A 5mm operative hysteroscope is passed through the cervix and into the uterine cavity using normal saline for uterine distention. Each tubal ostium is identified, followed by deployment of the device into each fallopian tube. A confirmatory test, hysterosalpingogram (...) in-office transcervical sterilization (Essure® procedure ) using standard technique. Procedure: In-office Transcervical Sterilization (Essure®) The standard transcervical sterilization procedure is not being evaluated in this study, and will be performed in the same manner in the two study arms. The procedure includes a standardized paracervical block with 1% lidocaine. A 5mm operative hysteroscope is passed through the cervix and into the uterine cavity using normal saline for uterine distention. Each

2014 Clinical Trials

162. Nitrous Oxide for Pain Management of First Trimester Surgical Abortion

/treatment Experimental: Nitrous oxide administration All participants will receive 800 mg of oral ibuprofen 30 minutes pre-operatively. All patients will receive local anesthesia via a standardized paracervical block with 18 cc of 1% lidocaine buffered with 2 ml of 8.4% sodium bicarbonate and 0.2 ml of 4 units of vasopressin. In addition, the Nitrous oxide group will receive two placebo pills. Nitrous oxide will be administered via a disposable scented nasal mask to blind patients to the intervention (...) oxygen intraoperatively. NO or oxygen will be administered via a scented nasal mask to blind patients to the intervention. All patients will get local anesthesia via a standardized PCB. No Intervention: Standard care group All participants will receive 800 mg of oral ibuprofen 30 minutes pre-operatively. All patients will receive local anesthesia via a standardized paracervical block with 18 cc of 1% lidocaine buffered with 2 ml of 8.4% sodium bicarbonate and 0.2 ml of 4 units of vasopressin

2014 Clinical Trials

163. Ovarian Stimulation With Recombinant Gonadotropins vs. Human Menopausal Gonadotropin in In Vitro Fertilization

mm diameter, with appropriate E2 levels. At this point, ovulation had been triggered by injecting subcutaneously 10,000 IU of human Chorionic Gonadotropin, and transvaginal US-guided oocyte aspiration (OPU) had been performed approximately 36-37 hours after hCG injection under local anesthesia (paracervical block). Classical IVF or ICSI had followed, according to the clinical indication. After two days of in vitro culture, embryos had been scored and 1-3 of them had been transferred in uteri

2014 Clinical Trials

164. Intrauterine lidocaine for pain control during laminaria insertion: a randomized controlled trial. (PubMed)

Intrauterine lidocaine for pain control during laminaria insertion: a randomized controlled trial. To determine if intrauterine administration of 5 cc of 2% lidocaine in addition to paracervical block reduces pain during laminaria insertion, when compared with paracervical block and saline placebo.This was a randomized, double blind placebo-controlled trial. Women presenting for abortion by dilation and evacuation (D&E) at 14-24 weeks gestational age were randomized to receive an intrauterine (...) instillation of either 5 mL of 2% lidocaine or 5 mL of normal saline, in addition to standard paracervical block with 20 cc of 0.25% bupivacaine. Our primary outcome was self-reported pain scores on a 100mm Visual Analogue Scale (VAS) immediately following laminaria insertion. Secondary outcome was self-reported VAS pain score indicating the maximum level of pain experienced during the 24-48-h interval between laminaria insertion and D&E procedure.Seventy-two women were enrolled, and data for 67 women were

2014 Contraception Controlled trial quality: predicted high

165. Surgical Management of Abortion (Treatment)

mcg can be helpful in cervical preparation. Cases that might find cervical preparation helpful include uterine abnormalities and history of caesarian delivery. Prior to insertion, the cervix is prepared with Betadine, but the sterile or "no-touch" technique should be used throughout the procedure. Laminaria insertion requires a single-toothed tenaculum to stabilize the cervix. A paracervical block with lidocaine can provide comfort. The cervix may require dilation with Pratt, Hegar or Denniston (...) procedures take only a few minutes. Single-toothed tenaculums are used to grasp the cervix after it has been prepared with Betadine. Local anesthetic is administered in a paracervical fashion. The agent used is usually 0.5-2% lidocaine or 1% Nesacaine. No epinephrine is necessary but epinephrine 1:200,000 may render the lidocaine more effective because it reduces absorption of lidocaine and decreases the risk of a vasovagal reaction. The maximum recommended dose of lidocaine is 4.5 mg/kg of body weight

2014 eMedicine.com

166. Chronic Pelvic Pain (Treatment)

the following: Trigger point injections: These injections are used mostly for localized trigger points (myofascial pain or neuroma). Peripheral nerve blocks: Specific peripheral nerve block with local anesthetic and steroids may be helpful in selected cases. Neuroablation of selected nerves can be performed by using different techniques, including thermocoagulation (radiofrequency ablation), cryoablation, or injection of chemical agents (alcohol, hypertonic saline, phenol). An intrathecal morphine pump may (...) be used, but careful selection for appropriate patients is very important. Sacral nerve stimulation may be effective in the treatment of therapy-resistant pelvic pain syndromes linked to pelvic floor dysfunction. [ ] Various surgical procedures may be considered to treat chronic pelvic pain. Surgical procedures include presacral neurectomy (superior hypogastric plexus excision), paracervical denervation (laparoscopic uterine nerve ablation), and uterovaginal ganglion excision (inferior hypogastric

2014 eMedicine.com

167. Gynecologic Cryosurgery (Treatment)

with pretreatment NSAIDs. Mucosal and paracervical block typically are not used. Hydrorrhea: Most authors describe 2-4 weeks of profuse watery discharge, which may be greater in obese women. Debridement of the cervical eschar 48 hours after the cryosurgical procedure does not ameliorate this symptom. [ ] Bleeding: This symptom is rare. Infection: This is a rare complication. Prophylactic antibiotics are not indicated. Cellular repair Crisp reports that 60% of patients were found to have normal histology

2014 eMedicine.com

168. Hysteroscopy (Treatment)

procedures can be completed without anesthesia, with a paracervical block alone, or with mild sedation. For extensive procedures or for patients with a low pain tolerance, general or regional anesthesia is indicated. If electrosurgery is to be performed, sufficient anesthesia must be given to ensure that the patient does not move with uterine stimulation because of the risk of uterine perforation and intraperitoneal injury. Positioning The patient is placed in the dorsal lithotomy position then prepared (...) for fibroids as large as 5 cm (oral communication). In addition to successful testing under , procedures using this device are also reported to be acceptable to sedated patients with use of a paracervical block. The system has the potential to beperformed in the office. Fibroids with an intramural component In general, nonhysteroscopic myomectomy should be considered for fibroids with greater than 50% myometrial extension (type II, G2 fibroids), which are technically the most difficult resections

2014 eMedicine.com

169. Infertility (Treatment)

be performed in the physician's office using local anesthesia (ie, paracervical block). Carbon dioxide hysteroscopy is for diagnostic purposes only and requires a constant flow of carbon dioxide. It does not require cervical dilation and allows a rather easy evaluation of the endometrial cavity. [ ] The operative hysteroscope has been designed based on the resectoscope principle. [ ] It allows both the diagnosis and treatment of endometrial pathology. The design of refined instruments (eg, scissors (...) in the semen. Mucus secretion may be altered by hormonal changes and medications, especially drugs like clomiphene citrate, which decrease the production. Hypoestrogenism may cause thickened cervical mucus, which impairs the passage of sperm. Cervical stenosis can cause infertility by blocking the passage of sperm from the cervix to the intrauterine cavity. Cervical stenosis can be congenital or acquired in etiology, resulting from surgical procedures, infections, hypoestrogenism, and radiation therapy

2014 eMedicine.com

170. Threatened Abortion (Treatment)

mcg can be helpful in cervical preparation. Cases that might find cervical preparation helpful include uterine abnormalities and history of caesarian delivery. Prior to insertion, the cervix is prepared with Betadine, but the sterile or "no-touch" technique should be used throughout the procedure. Laminaria insertion requires a single-toothed tenaculum to stabilize the cervix. A paracervical block with lidocaine can provide comfort. The cervix may require dilation with Pratt, Hegar or Denniston (...) procedures take only a few minutes. Single-toothed tenaculums are used to grasp the cervix after it has been prepared with Betadine. Local anesthetic is administered in a paracervical fashion. The agent used is usually 0.5-2% lidocaine or 1% Nesacaine. No epinephrine is necessary but epinephrine 1:200,000 may render the lidocaine more effective because it reduces absorption of lidocaine and decreases the risk of a vasovagal reaction. The maximum recommended dose of lidocaine is 4.5 mg/kg of body weight

2014 eMedicine.com

171. Therapeutic Abortion (Treatment)

mcg can be helpful in cervical preparation. Cases that might find cervical preparation helpful include uterine abnormalities and history of caesarian delivery. Prior to insertion, the cervix is prepared with Betadine, but the sterile or "no-touch" technique should be used throughout the procedure. Laminaria insertion requires a single-toothed tenaculum to stabilize the cervix. A paracervical block with lidocaine can provide comfort. The cervix may require dilation with Pratt, Hegar or Denniston (...) procedures take only a few minutes. Single-toothed tenaculums are used to grasp the cervix after it has been prepared with Betadine. Local anesthetic is administered in a paracervical fashion. The agent used is usually 0.5-2% lidocaine or 1% Nesacaine. No epinephrine is necessary but epinephrine 1:200,000 may render the lidocaine more effective because it reduces absorption of lidocaine and decreases the risk of a vasovagal reaction. The maximum recommended dose of lidocaine is 4.5 mg/kg of body weight

2014 eMedicine.com

172. Infertility (Overview)

be performed in the physician's office using local anesthesia (ie, paracervical block). Carbon dioxide hysteroscopy is for diagnostic purposes only and requires a constant flow of carbon dioxide. It does not require cervical dilation and allows a rather easy evaluation of the endometrial cavity. [ ] The operative hysteroscope has been designed based on the resectoscope principle. [ ] It allows both the diagnosis and treatment of endometrial pathology. The design of refined instruments (eg, scissors (...) in the semen. Mucus secretion may be altered by hormonal changes and medications, especially drugs like clomiphene citrate, which decrease the production. Hypoestrogenism may cause thickened cervical mucus, which impairs the passage of sperm. Cervical stenosis can cause infertility by blocking the passage of sperm from the cervix to the intrauterine cavity. Cervical stenosis can be congenital or acquired in etiology, resulting from surgical procedures, infections, hypoestrogenism, and radiation therapy

2014 eMedicine.com

173. Hysteroscopy (Overview)

enough to require minimal cervical dilation. In addition, patients tolerate this instrument well with only paracervical block anesthesia. Rigid scopes larger than 5 mm in diameter (commonly 8-10 mm) require increased cervical dilation for insertion. Therefore, they are most frequently used in the operating room with intravenous (IV) sedation or . Large instruments include an outer sheath to introduce and remove media and to provide ports to accommodate large and varied surgical instruments. Flexible

2014 eMedicine.com

174. Elective Abortion (Treatment)

mcg can be helpful in cervical preparation. Cases that might find cervical preparation helpful include uterine abnormalities and history of caesarian delivery. Prior to insertion, the cervix is prepared with Betadine, but the sterile or "no-touch" technique should be used throughout the procedure. Laminaria insertion requires a single-toothed tenaculum to stabilize the cervix. A paracervical block with lidocaine can provide comfort. The cervix may require dilation with Pratt, Hegar or Denniston (...) procedures take only a few minutes. Single-toothed tenaculums are used to grasp the cervix after it has been prepared with Betadine. Local anesthetic is administered in a paracervical fashion. The agent used is usually 0.5-2% lidocaine or 1% Nesacaine. No epinephrine is necessary but epinephrine 1:200,000 may render the lidocaine more effective because it reduces absorption of lidocaine and decreases the risk of a vasovagal reaction. The maximum recommended dose of lidocaine is 4.5 mg/kg of body weight

2014 eMedicine.com

175. Infertility (Follow-up)

be performed in the physician's office using local anesthesia (ie, paracervical block). Carbon dioxide hysteroscopy is for diagnostic purposes only and requires a constant flow of carbon dioxide. It does not require cervical dilation and allows a rather easy evaluation of the endometrial cavity. [ ] The operative hysteroscope has been designed based on the resectoscope principle. [ ] It allows both the diagnosis and treatment of endometrial pathology. The design of refined instruments (eg, scissors (...) in the semen. Mucus secretion may be altered by hormonal changes and medications, especially drugs like clomiphene citrate, which decrease the production. Hypoestrogenism may cause thickened cervical mucus, which impairs the passage of sperm. Cervical stenosis can cause infertility by blocking the passage of sperm from the cervix to the intrauterine cavity. Cervical stenosis can be congenital or acquired in etiology, resulting from surgical procedures, infections, hypoestrogenism, and radiation therapy

2014 eMedicine.com

176. Hysteroscopy (Follow-up)

procedures can be completed without anesthesia, with a paracervical block alone, or with mild sedation. For extensive procedures or for patients with a low pain tolerance, general or regional anesthesia is indicated. If electrosurgery is to be performed, sufficient anesthesia must be given to ensure that the patient does not move with uterine stimulation because of the risk of uterine perforation and intraperitoneal injury. Positioning The patient is placed in the dorsal lithotomy position then prepared (...) for fibroids as large as 5 cm (oral communication). In addition to successful testing under , procedures using this device are also reported to be acceptable to sedated patients with use of a paracervical block. The system has the potential to beperformed in the office. Fibroids with an intramural component In general, nonhysteroscopic myomectomy should be considered for fibroids with greater than 50% myometrial extension (type II, G2 fibroids), which are technically the most difficult resections

2014 eMedicine.com

177. Gynecologic Cryosurgery (Follow-up)

with pretreatment NSAIDs. Mucosal and paracervical block typically are not used. Hydrorrhea: Most authors describe 2-4 weeks of profuse watery discharge, which may be greater in obese women. Debridement of the cervical eschar 48 hours after the cryosurgical procedure does not ameliorate this symptom. [ ] Bleeding: This symptom is rare. Infection: This is a rare complication. Prophylactic antibiotics are not indicated. Cellular repair Crisp reports that 60% of patients were found to have normal histology

2014 eMedicine.com

178. Infertility (Diagnosis)

be performed in the physician's office using local anesthesia (ie, paracervical block). Carbon dioxide hysteroscopy is for diagnostic purposes only and requires a constant flow of carbon dioxide. It does not require cervical dilation and allows a rather easy evaluation of the endometrial cavity. [ ] The operative hysteroscope has been designed based on the resectoscope principle. [ ] It allows both the diagnosis and treatment of endometrial pathology. The design of refined instruments (eg, scissors (...) in the semen. Mucus secretion may be altered by hormonal changes and medications, especially drugs like clomiphene citrate, which decrease the production. Hypoestrogenism may cause thickened cervical mucus, which impairs the passage of sperm. Cervical stenosis can cause infertility by blocking the passage of sperm from the cervix to the intrauterine cavity. Cervical stenosis can be congenital or acquired in etiology, resulting from surgical procedures, infections, hypoestrogenism, and radiation therapy

2014 eMedicine.com

179. Hysteroscopy (Diagnosis)

enough to require minimal cervical dilation. In addition, patients tolerate this instrument well with only paracervical block anesthesia. Rigid scopes larger than 5 mm in diameter (commonly 8-10 mm) require increased cervical dilation for insertion. Therefore, they are most frequently used in the operating room with intravenous (IV) sedation or . Large instruments include an outer sheath to introduce and remove media and to provide ports to accommodate large and varied surgical instruments. Flexible

2014 eMedicine.com

180. Manual versus electric vacuum aspiration for first-trimester abortion: a systematic review

perforation, blood loss or severe pain perception, were eligible. The secondary outcomes were operation time, cost and acceptability of the abortion method. The studies were conducted in the USA, China and Sweden. Where reported, women were given paracervical block for pain management. The mean age of the participants ranged from 23 to 29 years, and gestational age ranged from ≤42 to ≤77 days. The duration of follow-up ranged from 1 to 8 weeks, with four only following up until discharge from hospital

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