Abstract
Objective
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.
Study Design
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 100 mm 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.
Results
Seventy-two women were enrolled, and data for 67 women were analyzed, only two of
whom were more than 21 weeks on gestation. The range of pain scores at both time points was large (1–90 mm at laminaria insertion; 0–100 mm in laminaria–D&E interval). Mean pain scores were not different between treatment
groups at laminaria insertion, (33 vs. 32, p=.8) or in the laminaria – D&E interval
(43 vs. 44, p=.9).
Conclusion
Intrauterine administration of 5 cc of 2% lidocaine in addition to paracervical block did not reduce pain with laminaria
insertion when compared to paracervical block with saline placebo.
Implications
Intrauterine lidocaine combined with paracervical block does not improve pain control
at laminaria insertion when compared with paracervical block and saline placebo. Wide
variation in pain scores and persistent pain after laminaria insertion suggests patient
would benefit from more effective methods of pain control at laminaria insertion and
during the post-laminaria interval.
Keywords
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Article info
Publication history
Published online: July 22, 2014
Accepted:
July 16,
2014
Received in revised form:
July 13,
2014
Received:
March 26,
2014
Footnotes
☆Funding: This study received financial support from the Department of Obstetrics and Gynecology at University of North Carolina Chapel Hill. The corresponding author was supported by an National Institutes of Health T-32 grant for clinical research (Grant #T32 HD 40672–11) and the North Carolina Translational and Clinical Sciences Institute. The Institute is supported by grants UL1RR025747, KL2RR025746, and TLRR025745 from the NIH National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health.
☆☆Neither author reports any potential financial or other conflict of interest.
★Clinical Trial Registration: ClinicalTrials.gov (NCT01541293).
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
