Lidocaine and Pain Management in First Trimester Abortions

Not Applicable

Completed

Brief Summary: The purpose of this study is to examine the effect of lidocaine (a numbing medication) inside the uterus on patient pain during an early abortion, compared to the paracervical block (lidocaine injected on either side of the cervix).

Detailed Description: The Investigators intend to conduct a randomized, patient-blinded control trial at Oregon Health and Science University and Planned Parenthood of the Columbia Willamette. Women will be approached about this study after they have made a decision to terminate the pregnancy. The women will be blinded and randomized into one of two study arms.

Group 1: the investigator will apply pressure with the capped needle of the paracervical block at the cervical-vaginal reflexion at 4 and 8 o'clock. This will approximate the steps involved in a paracervical block without injecting the patient. Following this, the patient will receive a 5 milliliter intrauterine infusion of 4% lidocaine using a sterile 3mm Novak curette. The infusion will be placed slowly over 3 minutes.

Group 2: a standard paracervical block (8 milliliter 1% lidocaine at 4 and 8 o'clock at the cervical-vaginal reflection) will be placed. Following this, a 3 mm Novak curette will be placed in the vagina and held to the external os of the cervix for 3 minutes. The curette will not be placed through the cervix and no infusion will be performed. This will approximate the steps involved in an intrauterine infusion without injecting the patient.

During the procedure, women in both groups will be asked to rate their pain at various times using a 10 cm visual analog scale (VAS).

Recruitment & Eligibility

Inclusion Criteria

Good general health
Age>18years
English speaking
Voluntarily requesting pregnancy termination
Have an estimated gestation of up to 76 days since the first day of the preceding menstrual period
Confirmed by ultrasound
Be able and willing to sign an informed consent
Agree to the terms of the study
All patients must be premedicated with Ibuprofen and Valium (per clinic protocols)

Exclusion Criteria

Significant physical or mental health condition
A gestational age of 77 days or more
Adnexal mass or tenderness on pelvic exam consistent with pelvic inflammatory disease
Patients who require or request IV/intramuscular sedation
Patients who refuse Ibuprofen, Valium and/or paracervical blocks
Patients allergic to lidocaine
Patients with known hepatic disease
Patients weighing less than 100 lbs

Arm && Interventions

Group	Intervention	Description
Lidocaine infusion	Lidocaine	5 milliliter intrauterine infusion of 4% lidocaine, infusion will be placed slowly over 3 minutes.
Paracervical block only	Lidocaine	Standard paracervical block (8 milliliter 1% lidocaine at 4 and 8 o'clock at the cervical-vaginal reflection) will be placed.

Primary Outcome Measures

Name	Time	Method
The Effects of an Intrauterine Lidocaine Infusion to Standard Paracervical Block on Decreasing Patient Pain Measured by Visual Analog Scale in First Trimester Abortions.	Immediately (time zero) at uterine aspiration	Subjects perception of pain is measured using a 100mm visual analog scale (VAS).The 100mm Pain Visual Analog Scale (VAS) is an instrument used to capture subjective attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of pain by indicating a position along a 100mm continues line: pain scores can range from 0 (no pain) to 100 (worst pain imaginable).

Secondary Outcome Measures

Name	Time	Method

Locations (2): Planned Parenthood of the Columbia Willamette
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Portland, Oregon, United States
Oregon Health and Science University
🇺🇸
Portland, Oregon, United States