Paracervical Block for Pain Control in First Trimester Abortion

An Evaluation of the Paracervical Block for Pain Control in First Trimester Surgical Abortion

Many woman undergoing a surgical abortion receive a paracervical nerve block for pain reduction, in which lidocaine (a numbing medication) is injected around the cervix. These injections numb the cervix and possibly the lower part of the uterus. However, the injection can be uncomfortable and it is not well known whether it is effective in reducing pain. The purpose of this study is to determine the level of pain women experience with a surgical abortion and the effect that paracervical block might have on that pain.

The investigators expect to have 120 women complete this study, between study sites at OHSU's Center for Women's Health and Planned Parenthood Columbia Willamette in Portland, OR. Every participant will still receive the standard oral medication for pain (ibuprofen) and anxiety (lorazepam). Eligible subjects will be at least 18 years of age, less than 11 weeks pregnant and have already decided to have a surgical abortion.

The primary outcome evaluated will be pain reported at time of cervical dilation. The investigators will assess pain at various time points (including secondary outcomes) immediately upon completion of the respective step and pain and satisfaction 30 minutes postoperatively.

Inclusion Criteria:

• Age: 18 years or older
• Voluntarily requesting pregnancy termination
• Ultrasound confirmed intrauterine pregnancy up to 10 6/7 weeks gestational age
• Good general health
• English or Spanish speaking
• Be able and willing to sign an informed consent and agree to terms of the study

Exclusion Criteria:

• Gestational ages over 11 0/7 weeks, due to routine misoprostol use at our institutions
• Incomplete abortion
• Required or requested narcotics or IV sedation (prior to randomization)
• Patients who refuse Ibuprofen and paracervical blocks
• Contraindications or allergies to lidocaine, ibuprofen or ativan
• Significant physical or mental health condition
• Adnexal mass or tenderness on pelvic exam consistent with pelvic inflammatory disease
• Patients with known hepatic disease
• Women, who in the opinion of the investigator are not suitable for the study protocol