Mankowski Jennifer L, Kingston Jessica, Moran Thomas, Nager Charles W, Lukacz Emily S
From the Department of Reproductive Medicine, University of California, San Diego Medical Center, and First Avenue Family Planning-Michelle Wagner Center, Planned Parenthood, San Diego, California.
Obstet Gynecol. 2009 May;113(5):1052-1057. doi: 10.1097/AOG.0b013e31819ec97e.
To estimate the efficacy of paracervical compared with intracervical administration of local anesthesia during first-trimester suction curettage.
A double-blind, randomized controlled trial comparing paracervical with intracervical lidocaine was performed in women undergoing elective first-trimester suction curettage with conscious sedation. Pain was assessed at baseline, with dilation, and with curettage using a 10-cm visual analog scale (VAS). Assuming a minimal clinically important difference in pain score of 1.6 cm and a mean pain score (+/-standard deviation [SD]) of 4.7 (+/-2.9) cm for paracervical block, 120 patients would provide 80% power with an alpha of .05.
For the 132 women randomly assigned, no significant differences in VAS scores (mean+/-SD) were observed between paracervical and intracervical blocks during dilation (2.6+/-2.3 compared with 2.8+/-2.2, P=.72) or curettage (3.9+/-2.9 compared with 3.3+/-2.5, P=.16).
For women undergoing first-trimester suction curettage with conscious sedation, there was no clinically meaningful difference in pain relief between paracervical and intracervical lidocaine. Providers should feel confident that both techniques provide equally effective and acceptable analgesia.
评估孕早期人工流产术中宫颈旁阻滞与宫颈内注射局部麻醉的效果。
对接受选择性孕早期人工流产术并采用清醒镇静的女性进行一项双盲随机对照试验，比较宫颈旁阻滞与宫颈内注射利多卡因的效果。在基线、扩宫时以及刮宫时使用10厘米视觉模拟评分法（VAS）评估疼痛程度。假设宫颈旁阻滞的疼痛评分最小临床重要差异为1.6厘米，平均疼痛评分为4.7（±2.9）厘米，120例患者将在α为0.05时提供80%的检验效能。
对于随机分配的132名女性，在扩宫时（2.6±2.3与2.8±2.2相比，P = 0.72）或刮宫时（3.9±2.9与3.3±2.5相比，P = 0.16），宫颈旁阻滞与宫颈内注射之间的VAS评分（均值±标准差）无显著差异。
对于接受孕早期人工流产术并采用清醒镇静的女性，宫颈旁阻滞与宫颈内注射利多卡因在缓解疼痛方面无临床意义上的差异。医疗人员应确信这两种技术都能提供同样有效且可接受的镇痛效果。
