Edelman Alison, Nichols Mark D, Leclair Catherine, Jensen Jeffrey T
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, 97239, USA.
Obstet Gynecol. 2006 Feb;107(2 Pt 1):269-75. doi: 10.1097/01.AOG.0000194204.71925.4a.
To study the effects of a 4% intrauterine lidocaine infusion on perceived patient pain in first-trimester abortions.
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.
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 microg/mL (lidocaine group). There was no difference in overall satisfaction between the 2 groups.
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.
I.
研究4%的利多卡因宫内输注对孕早期人工流产患者疼痛感受的影响。
一项随机、双盲、安慰剂对照试验，80名妇女在孕早期人工流产前接受5毫升4%利多卡因（n = 40）或生理盐水（n = 40）宫内输注及标准宫颈旁阻滞。妇女们完成一系列100毫米视觉模拟量表（锚定：0 =无，100毫米 = 可想象到的最严重）以测量她们的疼痛感受（预期疼痛、阴道窥器插入后、宫内输注后、宫颈扩张后、负压吸引后及术后30分钟）。8名妇女在利多卡因输注后自愿检测血清利多卡因水平。
两组在年龄、产次、既往流产史、种族、孕周及痛经程度方面相似。疼痛评分显示，在宫颈扩张期间（生理盐水组55毫米±26，利多卡因组35毫米±30，P <.01）和吸引期间（生理盐水组71毫米±20，利多卡因组43毫米±30，P <.01）两组间存在显著差异。利多卡因组报告的症状（即口腔麻木和刺痛）明显多于生理盐水组（生理盐水组0/39，利多卡因组16/38，42%，P <.01）。记录到的最高血清利多卡因水平为4.0微克/毫升（利多卡因组）。两组间总体满意度无差异。
与单纯宫颈旁阻滞相比，添加4%的利多卡因宫内输注可显著降低孕早期人工流产患者的疼痛感受。虽然利多卡因全身效应的主观症状很常见，但没有受试者的血清水平符合利多卡因毒性。然而，需要进一步研究以确定安全性。
I级
