Four percent intrauterine lidocaine infusion for pain management in first-trimester abortions

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

OBJECTIVE: To study the effects of a 4% intrauterine lidocaine infusion on perceived patient pain in first-trimester abortions. METHODS: A randomized, double-blind, placebo-controlled trial of 80 women receiving either a 5-mL 4% lidocaine (n = 40) or saline (n = 40) intrauterine infusion and a standard paracervical block before first-trimester abortion. Women completed a series of 100-mm visual analog scales (anchors: 0 = none, 100 mm = worst imaginable) to measure their perceived pain (anticipated pain, after speculum insertion, after intrauterine infusion, after cervical dilation, after suction aspiration, and 30 minutes postprocedure). Eight women volunteered for serum lidocaine levels after the lidocaine infusion. RESULTS: Groups were similar in respect to age, parity, prior abortion, ethnicity, gestational age, and level of dysmenorrhea. Pain scores demonstrated a significant difference between groups during cervical dilation (saline 55 mm ± 26, lidocaine 35 mm ± 30, P <.01) and during aspiration (saline 71 mm ± 20, lidocaine 43 mm ± 30, P <.01). The lidocaine group reported significantly more symptoms (ie, oral numbness and tingling) than the saline group (saline 0/39, lidocaine 16/38, 42%, P <.01). The highest serum lidocaine level recorded was 4.0 μg/mL (lidocaine group). There was no difference in overall satisfaction between the 2 groups. CONCLUSION: Compared with paracervical block alone, the addition of a 4% intrauterine lidocaine infusion resulted in a significant reduction in patient perception of pain during first-trimester abortion. Although subjective symptoms of systemic lidocaine effect were common, no subjects demonstrated serum levels consistent with lidocaine toxicity. However, further studies to determine safety are needed.

Original languageEnglish (US)
Pages (from-to)269-275
Number of pages7
JournalObstetrics and Gynecology
Volume107
Issue number2 I
DOIs
StatePublished - Feb 2006

Fingerprint

First Pregnancy Trimester
Pain Management
Lidocaine
Obstetrical Anesthesia
Pain
Dilatation
Serum
Dysmenorrhea
Pain Perception
Hypesthesia
Suction
Parity
Visual Analog Scale
Surgical Instruments
Gestational Age
Placebos

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Four percent intrauterine lidocaine infusion for pain management in first-trimester abortions. / Edelman, Alison; Nichols, Mark D.; Leclair, Catherine; Jensen, Jeffrey.

In: Obstetrics and Gynecology, Vol. 107, No. 2 I, 02.2006, p. 269-275.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To study the effects of a 4{\%} intrauterine lidocaine infusion on perceived patient pain in first-trimester abortions. METHODS: A randomized, double-blind, placebo-controlled trial of 80 women receiving either a 5-mL 4{\%} lidocaine (n = 40) or saline (n = 40) intrauterine infusion and a standard paracervical block before first-trimester abortion. Women completed a series of 100-mm visual analog scales (anchors: 0 = none, 100 mm = worst imaginable) to measure their perceived pain (anticipated pain, after speculum insertion, after intrauterine infusion, after cervical dilation, after suction aspiration, and 30 minutes postprocedure). Eight women volunteered for serum lidocaine levels after the lidocaine infusion. RESULTS: Groups were similar in respect to age, parity, prior abortion, ethnicity, gestational age, and level of dysmenorrhea. Pain scores demonstrated a significant difference between groups during cervical dilation (saline 55 mm ± 26, lidocaine 35 mm ± 30, P <.01) and during aspiration (saline 71 mm ± 20, lidocaine 43 mm ± 30, P <.01). The lidocaine group reported significantly more symptoms (ie, oral numbness and tingling) than the saline group (saline 0/39, lidocaine 16/38, 42{\%}, P <.01). The highest serum lidocaine level recorded was 4.0 μg/mL (lidocaine group). There was no difference in overall satisfaction between the 2 groups. CONCLUSION: Compared with paracervical block alone, the addition of a 4{\%} intrauterine lidocaine infusion resulted in a significant reduction in patient perception of pain during first-trimester abortion. Although subjective symptoms of systemic lidocaine effect were common, no subjects demonstrated serum levels consistent with lidocaine toxicity. However, further studies to determine safety are needed.",
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N2 - OBJECTIVE: To study the effects of a 4% intrauterine lidocaine infusion on perceived patient pain in first-trimester abortions. METHODS: A randomized, double-blind, placebo-controlled trial of 80 women receiving either a 5-mL 4% lidocaine (n = 40) or saline (n = 40) intrauterine infusion and a standard paracervical block before first-trimester abortion. Women completed a series of 100-mm visual analog scales (anchors: 0 = none, 100 mm = worst imaginable) to measure their perceived pain (anticipated pain, after speculum insertion, after intrauterine infusion, after cervical dilation, after suction aspiration, and 30 minutes postprocedure). Eight women volunteered for serum lidocaine levels after the lidocaine infusion. RESULTS: Groups were similar in respect to age, parity, prior abortion, ethnicity, gestational age, and level of dysmenorrhea. Pain scores demonstrated a significant difference between groups during cervical dilation (saline 55 mm ± 26, lidocaine 35 mm ± 30, P <.01) and during aspiration (saline 71 mm ± 20, lidocaine 43 mm ± 30, P <.01). The lidocaine group reported significantly more symptoms (ie, oral numbness and tingling) than the saline group (saline 0/39, lidocaine 16/38, 42%, P <.01). The highest serum lidocaine level recorded was 4.0 μg/mL (lidocaine group). There was no difference in overall satisfaction between the 2 groups. CONCLUSION: Compared with paracervical block alone, the addition of a 4% intrauterine lidocaine infusion resulted in a significant reduction in patient perception of pain during first-trimester abortion. Although subjective symptoms of systemic lidocaine effect were common, no subjects demonstrated serum levels consistent with lidocaine toxicity. However, further studies to determine safety are needed.

AB - OBJECTIVE: To study the effects of a 4% intrauterine lidocaine infusion on perceived patient pain in first-trimester abortions. METHODS: A randomized, double-blind, placebo-controlled trial of 80 women receiving either a 5-mL 4% lidocaine (n = 40) or saline (n = 40) intrauterine infusion and a standard paracervical block before first-trimester abortion. Women completed a series of 100-mm visual analog scales (anchors: 0 = none, 100 mm = worst imaginable) to measure their perceived pain (anticipated pain, after speculum insertion, after intrauterine infusion, after cervical dilation, after suction aspiration, and 30 minutes postprocedure). Eight women volunteered for serum lidocaine levels after the lidocaine infusion. RESULTS: Groups were similar in respect to age, parity, prior abortion, ethnicity, gestational age, and level of dysmenorrhea. Pain scores demonstrated a significant difference between groups during cervical dilation (saline 55 mm ± 26, lidocaine 35 mm ± 30, P <.01) and during aspiration (saline 71 mm ± 20, lidocaine 43 mm ± 30, P <.01). The lidocaine group reported significantly more symptoms (ie, oral numbness and tingling) than the saline group (saline 0/39, lidocaine 16/38, 42%, P <.01). The highest serum lidocaine level recorded was 4.0 μg/mL (lidocaine group). There was no difference in overall satisfaction between the 2 groups. CONCLUSION: Compared with paracervical block alone, the addition of a 4% intrauterine lidocaine infusion resulted in a significant reduction in patient perception of pain during first-trimester abortion. Although subjective symptoms of systemic lidocaine effect were common, no subjects demonstrated serum levels consistent with lidocaine toxicity. However, further studies to determine safety are needed.

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