Pain Scoring in Uterine Evacuation for Incomplete Abortion Using Isolated Paracervical Block vs Combined Paracervical and Intrauterine Lignocaine Instillation: A Randomized Clinical Trial

Abstract Background Nerve block is a technique whereby local anesthetic solutions are infiltrated around a nerve (or perineurally) to provide anesthesia and analgesia. Nerve block for intraoperative and postoperative pain management is associated with improved analgesia, fewer opioid-related adverse events, earlier ambulation and shorter hospital stay when compared to intravenous opioid analgesia alone. Objective To compare efficacy of paracervical block alone versus combined paracervical block and intrauterine lidocaine installation in pain management of first trimesteric incomplete abortion. Patients and Methods A total of 80 women with first trimesteric incomplete miscarriage were admitted to the emergency department for uterine evacuation at Ain Shams University Maternity Hospital, in the period from September 2021 to September 2023 and underwent uterine evacuation using either paracervical block or combined paracervical block and intrauterine lidocaine instillation then pain score was obtained using visual analogue scale. Pain score was done 10 minutes after injection of local anaesthetic, 5 minutes after starting procedure and 1 hour postevacuation. Results It also showed that there was no statistically significant difference between both groups regarding need of opioids and time interval till opioids need. Exploring other factors that might have affected the success or failure of procedure in the study population it was found that age, parity were significant predictors such that the younger the age, the less the parity the more likely failure of procedure. Also being previous section was linked more to success than failure. Conclusion The combination of intrauterine lidocaine and paracervical block has no additive effect on conventional paracervical block in reducing the pain during uterine evacuation for incomplete abortion, but successful evacuation resulted in lower pain score and reduced needs for opioid.