A comparison of several ways of performing the paracervical block during the first trimester of pregnancy termination
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 3, Pages 971-978
AbstractAbortion is the termination of a pregnancy prior to the possibility of the baby being born alive; it may happen naturally or it can be induced. Just 10% of clinics in Turkey make use of general anaesthesia (GA), whereas 58% of clinics make use of local anaesthesia (LA) with or without oral premedication, and 32% of clinics make use of intravenous sedation in conjunction with LA
Aims and Objectives: This study compares the several ways of performing the paracervical block during the first trimester of pregnancy termination and examines whether variations in placement of local anesthetic in paracervical blocks influence effectiveness using local anesthetic is superior to saline.
Material and methods: This is a prospective comparison research on 200 pregnant women who arrived to either an outpatient clinic for prenatal care with a first-trimester abortion or an emergency department prepared for a D&C procedure. Two hundred women with ASA I-II who were diagnosed to undergo an abortion by ultrasonography and who presented for termination of pregnancy by suction and curettage. Group A: One hundred women were randomly assigned to have a PCB injection of five millilitres of lidocaine solution containing two percent (100 milligrammes) in each side of the cervix at the three and nine o'clock positions. Group B: One hundred ladies were given GA. During the GA, an intravenous bolus of propofol ranging from 2.5–4 mg/kg was administered as an intravenous anaesthetic in combination with an intravenous dose of 1 g/kg of fentanyl administered through intravenous route.
Results: The results of this study showed that pain assessment during D&C in group A: PCB was most commonly moderate during dilatation and mild pain during aspiration and curettage (50, 80, and 55%, respectively), whereas immediately after the procedure, 95% of the patients felt mild pain according to the VRS. The VAS was used to analyse the patient's level of pain, and the results showed that the dilatation caused a pain score of 3.74±2.41, the aspiration caused a pain score of 3.44±0.83, the curettage caused a pain score of 4.22±1.24, and the pain score immediately after the treatment was 2.72±0.59. The results of this investigation demonstrated that after one hour, pain ratings were lower in the sample that was treated with LA (2.18±0.63) than GA (3.02±1.04), and the difference between the two groups was statistically and clinically significant (P=0.001)
Conclusion: With the stipulation that we wait a few minutes before initiating the treatment, we have determined that the PCB is preferable to general anaesthesia. Our decision was reached after much deliberation. This is due to the fact that the PCB assures the patient's comfort while avoiding the harmful effects of general anaesthesia
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