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Meta-Analysis
. 2013 Sep 30;2013(9):CD005056.
doi: 10.1002/14651858.CD005056.pub3.

Paracervical local anaesthesia for cervical dilatation and uterine intervention

Thumwadee Tangsiriwatthana, Ussanee S Sangkomkamhang, Pisake Lumbiganon, Malinee Laopaiboon
Meta-Analysis

Paracervical local anaesthesia for cervical dilatation and uterine intervention

Thumwadee Tangsiriwatthana et al. Cochrane Database Syst Rev. .

Abstract

Background: Cervical dilatation and uterine intervention can be performed under sedation, local or general anaesthesia for obstetrics and gynaecological conditions. Many gynaecologists use paracervical local anaesthesia but its effectiveness is unclear. This review was originally published in 2009 and was updated in 2013.

Objectives: The objectives of this review were to determine the effectiveness and safety of paracervical local anaesthesia for cervical dilatation and uterine intervention, versus no treatment, placebo, other methods of regional anaesthesia, sedation and systemic analgesia, and general anaesthesia.

Search methods: We reran our search to August 2013. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE (1966 to August 2013), EMBASE (1980 to August 2013), and reference lists of articles. The original search was performed in January 2006.

Selection criteria: We included randomized or controlled clinical studies involving women who underwent cervical dilatation and uterine intervention for obstetrics and gynaecological conditions. We included studies which compared paracervical anaesthesia with no treatment, placebo, other methods of regional anaesthesia, systemic sedation and analgesia, or general anaesthesia.

Data collection and analysis: Two authors independently evaluated the studies, extracted data, and checked and entered data into Review Manager.

Main results: This updated review includes nine new studies, in total 26 studies with 28 comparisons and involving 2790 participants. No study of local paracervical versus general anaesthesia met our criteria. Ten studies compared local anaesthetic versus placebo. Paracervical local anaesthetic (PLA) reduced pain on cervical dilatation with a standardized mean difference (SMD) of 0.37 (95% CI 0.17 to 0.58) and a relative risk (RR) of severe pain of 0.16 (95% CI 0.06 to 0.74). PLA also reduced abdominal pain during, but not after, uterine intervention (SMD 0.74, 95% CI 0.28 to 1.19); there was no evidence of any effect on postoperative back or shoulder pain. Comparisons against no treatment did not demonstrate any effect of PLA. Five studies compared paracervical block with uterosacral block, intracervical block, or intrauterine topical anaesthesia. Two of these studies showed no significant difference in pain during the procedure. Compared to intrauterine instillation, PLA slightly reduced severe pain (from 8.3 to 7.6 on a 10-point scale), which may be negligible. Six studies compared PLA with sedation. There were no statistically significant differences in pain during or after the procedure, postoperative analgesia requirement, adverse effects, patient satisfaction, and the operator's perception of analgesia. We performed risk of bias assessment using six domains and found that more than half of the included studies had low risk of bias.

Authors' conclusions: We found that no technique provided reliable pain control in the 26 included studies. Some studies reported that women experienced severe pain (mean scores of 7 to 9 out of 10) during uterine intervention, irrespective of the analgesic technique used. We concluded that the available evidence fails to show whether paracervical block is inferior, equivalent, or superior to alternative analgesic techniques in terms of efficacy and safety for women undergoing cervical dilatation and uterine interventions. We suggest that woman are likely to consider the rates and severity of pain during uterine interventions when performed awake to be unacceptable in the absence of neuraxial blockade, which are unaltered by paracervical block.

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Conflict of interest statement

Thumwadee Tangsiriwatthana: none know

Ussanee S Sangkomkamhang: none known

Pisake Lumbiganon: none known

Malinee Laopaiboon: none known

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Searching results
1.1
1.1. Analysis
Comparison 1 Paracervical versus placebo, Outcome 1 Pain on speculum insertion.
1.2
1.2. Analysis
Comparison 1 Paracervical versus placebo, Outcome 2 Pain on tenaculum placement.
1.3
1.3. Analysis
Comparison 1 Paracervical versus placebo, Outcome 3 Pain dilating cervix.
1.4
1.4. Analysis
Comparison 1 Paracervical versus placebo, Outcome 4 Pain during uterine interventions.
1.5
1.5. Analysis
Comparison 1 Paracervical versus placebo, Outcome 5 Risk of any pain during uterine interventions.
1.6
1.6. Analysis
Comparison 1 Paracervical versus placebo, Outcome 6 Risk of severe pain during uterine intervention.
1.7
1.7. Analysis
Comparison 1 Paracervical versus placebo, Outcome 7 Postoperative pain.
1.8
1.8. Analysis
Comparison 1 Paracervical versus placebo, Outcome 8 Shoulder pain.
1.9
1.9. Analysis
Comparison 1 Paracervical versus placebo, Outcome 9 Adverse effects.
2.1
2.1. Analysis
Comparison 2 Paracervical versus no anaesthesia, Outcome 1 Postoperative pain at different times.
3.1
3.1. Analysis
Comparison 3 Paracervical block versus other regional anaesthesia, Outcome 1 Pain during cervical dilatation.
3.2
3.2. Analysis
Comparison 3 Paracervical block versus other regional anaesthesia, Outcome 2 Pain during uterine intervention: continuous.
3.3
3.3. Analysis
Comparison 3 Paracervical block versus other regional anaesthesia, Outcome 3 Postoperative pain at different time: continuous.
4.1
4.1. Analysis
Comparison 4 Paracervical versus systemic analgesia, Outcome 1 Pain during uterine intervention.
4.2
4.2. Analysis
Comparison 4 Paracervical versus systemic analgesia, Outcome 2 Postoperative pain.
4.3
4.3. Analysis
Comparison 4 Paracervical versus systemic analgesia, Outcome 3 Adverse effects.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Al‐Sunaidi 2007 {published data only}
    1. Al‐Sunaidi M, Tulandi T. A randomized trial comparing local intracervical and combined local and paracervical anesthesia in outpatient hysteroscopy. Journal of Minimally Invasive Gynacology 2007;14:153‐5. [PUBMED: 17368248] - PubMed
Amirian 2009 {published data only}
    1. Amirian M, Rajai M, Alavi A, Zare S, Aliabadi E. Comparison of lidocaine 1% and normal saline in paracervical anesthesia for decreasing of pain in curettage. Pakistan Journal of Biological Sciences 2009;12(11):877‐81. [PUBMED: 19803123] - PubMed
Buppasiri 2005 {published data only}
    1. Buppasiri P, Tangmanowutikul S, Yoosuk W. Randomized controlled trial of mefenamic acid vs paracervical block for relief of pain for outpatient uterine curettage. Journal of the Medical Association of Thailand 2005;88(7):881‐5. [PUBMED: 16241013] - PubMed
Carroll 2005 {published data only}
    1. Carroll Sr CS, Hines RS, Haddad GF, Robinette LG, May WL, Cowan BD. Randomized trial of paracervical block with endometrial biopsy. Journal of Pelvic Medicine and Surgery 2005;11(1):45‐8. [EMBASE: 2005159680]
Chanrachakul 2001 {published data only}
    1. Chanrachakul B, Likittanasombut P, O‐Prasertsawat P, Herabutya Y. Lidocaine versus plain saline for pain relief in fractional curettage: a randomized controlled trial. Obstetrics and Gynecology 2001;98(4):592‐5. [PUBMED: 11576573] - PubMed
Chatfield 1970 {published data only}
    1. Chatfield WR, Suter PE, Kotonya AO. Paracervical block anaesthesia for the evacuation of incomplete abortion ‐ a controlled trial. The Journal of Obstetrics and Gynaecology of the British Commonwealth 1970;77:462‐3. [PUBMED: 4913514] - PubMed
Chudnoff 2010 {published data only}
    1. Chudnoff S. Paracervical block efficacy in office hysteroscopic sterilization. Obstetrics and Gynecology January 2010;115(1):26‐34. [PUBMED: 20027030] - PubMed
Cicinelli 1998 {published data only}
    1. Cicinelli E, Didonna T, Schonauer LM, Stragapede S, Falco N, Pansini N. Paracervical anesthesia for hysteroscopy and endometrial biopsy in postmenopausal women: a randomized, double‐blind, placebo‐controlled study. The Journal of Reproductive Medicine 1998;43(12):1014‐8. [PUBMED: 9883403 ] - PubMed
Egziabher 2002 {published data only}
    1. Egziabher TG, Ruminjo JK, Sekadde‐Kigondu C. Pain relief using paracervical block in patients undergoing manual vacuum aspiration of uterus. East African Medical Journal 2002;79(10):530‐4. [PUBMED: 12635758] - PubMed
Finikiotis 1992 {published data only}
    1. Finikiotis G, Tsocanos S. Outpatient hysteroscopy: a comparison of 2 methods of local analgesia. The Australian & New Zealand Journal of Obstetrics & Gynaecology 1992;32(4):373‐4. [PUBMED: 1290441] - PubMed
Glantz 2001 {published data only}
    1. Glantz JC, Shomento S. Comparison of paracervical block techniques during first trimester pregnancy termination. International Journal of Gynaecology and Obstetrics 2001;72:171‐8. [PUBMED: 11166751] - PubMed
Gómez 2004 {published data only}
    1. Gómez PI, Gaitán H, Nova C, Paradas A. Paracervical block in incomplete abortion using manual vacuum aspiration: randomized clinical trial. Obstetrics and Gynecology 2004;103(5):943‐51. [PUBMED: 15121569] - PubMed
Guida 2003 {published data only}
    1. Guida M, Pellicano M, Zullo F, Acunzo G, Lavitola G, Palomba S, et al. Outpatient operative hysteroscopy with bipolar electrode: A prospective multicentre randomized study between local anaesthesia and conscious sedation. Human Reproduction 2003;18(4):840‐3. [PUBMED: 12660281] - PubMed
Kan 2004 {published data only}
    1. Kan AS, Ng EH, Ho PC. The role and comparison of two techniques of paracervical block for pain relief during suction evacuation for first‐trimester pregnancy termination. Contraception 2004;70:159‐63. [PUBMED: 15288222] - PubMed
Lau 1999 {published data only}
    1. Lau WC, Lo WK, Tam WH, Yuen PM. Paracervical anaesthesia in outpatient hysteroscopy: A randomised double‐blind placebo‐controlled trial. British Journal of Obstetrics and Gynaecology 1999;106:356‐9. [PUBMED: 10426243] - PubMed
Lazenby 2009 {published data only}
    1. Lazency GB, Fogelson NS, Aeby T. Impact of paracervical block on postabortion pain in patients undergoing abortion under anesthesia. Contraception 2009;80:578‐82. [CENTRAL: 00732391] - PubMed
Lopez 2007 {published data only}
    1. Lopez JC, Vigil‐De‐Gracia P, Vega‐Malek JC, Ruiz E, Vergara V. A randomized comparison of different methods of analgesia in abortion using manual vacuum aspiration. International Journal of Gynecology and Obstetrics Nov 2007;99(2):91‐4. [PUBMED: 17628562] - PubMed
Mankowski 2009 {published data only}
    1. Mankowski JL, Kingston J, Moran T, Nager CW, Lukacz ES. Paracervical compared with intracervical lidocaine for suction curettage: A randomized controlled trial. Obstetrics and Gynecology May 2009;113(5):1052‐7. [CENTRAL: 00698461] - PubMed
Miller 1996 {published data only}
    1. Miller L, Jensen MP, Stenchever MA. A double‐blind randomized comparison of lidocaine and saline for cervical anesthesia. Obstetrics and Gynecology 1996;87(4):600‐4. [PUBMED: 8602315] - PubMed
Mola 1996 {published data only}
    1. Mola G, Sapuri M, Bergström S. Simplified care of women with prolonged or persistent retention of the placenta: the use of paracervical block. Tropical Doctor 1996;26(3):116‐8. [PUBMED: 8783954] - PubMed
Renner 2012 {published data only}
    1. Renner RM, Nichols MD, Jensen JT, Li H, Edelman AB. Paracervical block for pain control in first‐trimester surgical abortion: A randomized controlled trial. Obstetrics and Gynecology 2012;119(5):1030‐7. [PUBMED: 22525915] - PubMed
Sharma 2009 {published data only}
    1. Sharma JB, Aruna J, Kumar P, Roy KK, Malhotra N, Kumar S. Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and indometrial biopsy. Indian Journal of Medical Sciences 2009;63(6):244‐52. [PUBMED: 19602758] - PubMed
Thongrong 2011 {published data only}
    1. Thongrong P, Jarruwale P, Panichkul P. Effectiveness of paracervical block versus intravenous morphine during uterine curettage: A randomized controlled trial. Journal of The Medical Association of Thailand 2011;94(4):403‐7. [PUBMED: 21591523 ] - PubMed
Titapant 2003 {published data only}
    1. Titapant V, Chawanpaiboon S, Boonpektrakul K. Double‐blind randomized comparison of xylocaine and saline in paracervical block for diagnostic fractional curettage. Journal of the Medical Association of Thailand (Chotmaihet Thangphaet) 2003;86(2):131‐5. [PUBMED: 12678150] - PubMed
Vercellini 1994 {published data only}
    1. Vercellini P, Colombo A, Mauro F, Oldani S, Bramante T, Crosignani PG. Paracervical anesthesia for outpatient hysteroscopy. Fertility and Sterility 1994;62(5):1083‐5. [PUBMED: 7646610] - PubMed
Yazaci 2003 {published data only}
    1. Yazici FG, Arslan M, Birbicer H, Kanik A, Aban M, Oral U. Comparison of the intrauterine topical anaesthesia and paracervical block on pain in patients undergoing endometrial biopsy. The Pain Clinic 2003;15(3):339‐43. [CENTRAL: CN‐00474484; EMBASE: 2003375070]

References to studies excluded from this review

Agostini 2003 {published data only}
    1. Agostini A, Bretelle F, Cravello L, Maisonneuve AS, Roger V, Blanc B. Acceptance of outpatient flexible hysteroscopy by premenopausal and postmenopausal women. The Journal of Reproductive Medicine 2003;48(6):441‐3. [PUBMED: 12856515] - PubMed
Agostini 2008 {published data only}
    1. Agostini A, Provansal M, Collette E, Capelle M, Estrade JP, Cravello L, et al. Comparison of ropivacaine and lidocaine for paracervical block during surgical abortion. Contraception 2008;77(5):382‐5. [PUBMED: 18402857 ] - PubMed
Allen 2006 {published data only}
    1. Allen RH, Kumar D, Fitzmaurice G, Lifford KL, Goldberg AB. Pain management of first‐trimester surgical abortion: effects of selection of local anesthesia with and without lorazepam or intravenous sedation. Contraception 2006;74(5):407‐13. [PUBMED: 17046383] - PubMed
Allen 2009 {published data only}
    1. Allen RH, Fitzmaurice G, Lifford KL, Lasic M, Goldberg AB. Oral compared with intravenous sedation for first‐trimester surgical abortion: A randomized controlled trial. Obstetrics and Gynecology 2009;113(2 Part 1):276‐83. [PUBMED: 19155895] - PubMed
Bain 2001 {published data only}
    1. Bain C, Cooper KG, Parkin DE. A partially randomized patient preference trial of microwave endometrial ablation using local anaesthesia and intravenous sedation or general anaesthesia: A pilot study. Gynaecological Endoscopy 2001;10:223‐8. [DOI: 10.1046/j.1365-2508.2001.00457.x] - DOI
Baskett 1974 {published data only}
    1. Baskett TF, Carson RM. Paracervical block with bupivacaine. Canadian Medical Association Journal 1974;110(12):1363‐5. [PUBMED: 4834527] - PMC - PubMed
Bradley 1995 {published data only}
    1. Bradley LD, Widrich T. State‐of‐the‐art flexible hysteroscopy for office gynecologic evaluation. The Journal of the American Association of Gynecologic Laparoscopists 1995;2(3):263‐7. [PUBMED: 9050568] - PubMed
Broadbent 1992 {published data only}
    1. Broadbent JA, Hill NC, Molnár BG, Rolfe KJ, Magos AL. Randomized placebo controlled trial to assess the role of intracervical lignocaine in outpatient hysteroscopy. British Journal of Obstetrics and Gynaecology 1992;99:777‐80. [PUBMED: 1420022] - PubMed
Canni 2001 {published data only}
    1. Cannì M, Gallia L, Fanzago E, Bocci F, Bertini U, Barbero M. Day‐surgery operative hysteroscopy with loco‐regional anesthesia. Minerva Ginecologica 2001;53(5):307‐11. [PUBMED: 11549994] - PubMed
Cansino 2009 {published data only}
    1. Cansino C, Edelman A, Burke A, Jamshidi R. Paracervical block with combined ketorolac and lidocaine in first‐trimester surgical abortion: A randomized controlled trial. Obstetrics and Gynecology Dec 2009;114(6):1220‐6. [PUBMED: 19935022] - PubMed
Cetin 1997 {published data only}
    1. Cetin A, Cetin M. Effect of deep injections of local anesthetics and basal dilatation of cervix in management of pain during legal abortions. A randomized, controlled study. Contraception 1997;56(2):85‐7. [PUBMED: 9315416] - PubMed
Chen 1994 {published data only}
    1. Chen RJ, Chow SN, Huang SC. A study on the usefulness of local anaesthesia for the laser vaporization of conizations in the uterine cervix. Annals of the Academy of Medicine, Singapore 1994;23(1):46‐8. [PUBMED: 8185271] - PubMed
Duggan 1999 {published data only}
    1. Duggan PM, Dodd J. Endometrial balloon ablation under local analgesia and intravenous sedation. The Australian & New Zealand Journal of Obstetrics & Gynaecology 1999;39(1):123‐6. [PUBMED: 10099769] - PubMed
Duncan 2005 {published data only}
    1. Duncan ID, McKinley CA, Pinion SB, Wilson SM. A double‐blind, randomized, placebo‐controlled trial of prilocaine and felypressin (Citanest and Octapressin) for the relief of pain associated with cervical biopsy and treatment with the Semm coagulator. Journal of Lower Genital Tract Disease 2005;9(3):171‐5. [PUBMED: 16044058] - PubMed
Edelman 2004 {published data only}
    1. Edelman A, Nichols MD, Leclair C, Astley S, Shy K, Jensen JT. Intrauterine lidocaine infusion for pain management in first‐trimester abortions. Obstetrics and Gynecology 2004;103(6):1267‐72. [PUBMED: 15172863] - PubMed
Esteve 2002 {published data only}
    1. Esteve M, Schindler S, Machado SB, Borges SA, Santos CR, Coutinho E. The efficacy of intracervical lidocaine in outpatient hysteroscopy. Gynecological Endoscopy 2002;11(1):33‐6. [CENTRAL: CN‐00404997; EMBASE: 2002181855 ]
Grimes 1979 {published data only}
    1. Grimes DA, Schulz KF, Cates W Jr, Tyler CW Jr. Local versus general anesthesia: which is safer for performing suction curettage abortions?. American Journal of Obstetrics and Gynecology 1979;135(8):1030‐5. [PUBMED: 517587] - PubMed
Guasch 2005 {published data only}
    1. Guasch E, Ardoy M, Cuadrado C, González Gancedo P, González A, Gilsanz F. Comparison of 4 anesthetic techniques for in vitro fertilization [Comparacion de cautro tecnicas anaestesicas para fedundacion in vitro]. Revista Espanola de Anestesiologia y Reanimacion 2005;52(1):9‐18. [PUBMED: 15747701] - PubMed
Gudgeon 1968 {published data only}
    1. Gudgeon DH. Paracervical block with bupivacaine 2.5 per cent. British Medical Journal 1968;18(2):403. [PUBMED: 5649001] - PMC - PubMed
Habersetzer 1972 {published data only}
    1. Habersetzer B, Raudrant D, Broussard P. Uterine evacuation under local anesthesia by paracervical block with xylocaine (apropos of 40 cases). Journal de Médecine de Lyon 1972 Nov 5;53(236):1495‐513. [PUBMED: 4644343] - PubMed
Harper 1994 {published data only}
    1. Harper DM, Walstatter BS, Lofton BJ. Anesthetic blocks for loop electrosurgical excision procedure. The Journal of Family Practice 1994;39(3):249‐56. [PUBMED: 8077904] - PubMed
Harper 1997 {published data only}
    1. Harper DM. Paracervical block diminishes cramping associated with cryosurgery. The Journal of Family Practice 1997 Jan;44(1):71‐5. [PUBMED: 9010373] - PubMed
Harper 1998 {published data only}
    1. Harper DM, Cobb JL. Cervical mucosal block effectively reduces the pain and cramping from cryosurgery. The Journal of Family Practice 1998;47(4):285‐9. [PUBMED: 9789514] - PubMed
Hasham 1993 {published data only}
    1. Hasham F, Mooney P, Garry R, Kokri MS. Bupivacaine paracervical block following ablation of the endometrium. British Journal of Obstetrics and Gynaecology 1993;100(8):788‐9. [PUBMED: 8399024] - PubMed
Hedberg 1966 {published data only}
    1. Hedberg G. Uterine curettage as an ambulant procedure performed with paracervical anaesthesia. Gynaecologia 1966;162(3):213‐5. [PUBMED: 5958922] - PubMed
Jensen 1984 {published data only}
    1. Jensen F, Qvist I, Brocks V, Secher NJ, Westergaard LG. Submucous paracervical blockade compared with intramuscular meperidine as analgesia during labor: a double blind study. Obstetrics and Gynecology 1984;64(5):724‐7. [PUBMED: 6387560] - PubMed
Johnson 1989 {published data only}
    1. Johnson N, Crompton AC, Ramsden SV. The efficacy of paracervical injections of lignocaine before laser ablation of the cervical transformation zone. A randomized placebo‐controlled double‐blind clinical trial. British Journal of Obstetrics and Gynaecology 1989;96(12):1410‐2. [PUBMED: 2695156] - PubMed
Johnson 1996 {published data only}
    1. Johnson N, Crompton AC, Doodek U. Comparing paracervical with direct infiltration of lignocaine for cervical laser surgery. Journal of Gynecologic Surgery 1996;12(3):197‐9. [CENTRAL: CN‐00171124; EMBASE: 1996335557]
Kamat 1979 {published data only}
    1. Kamet DS, Dani SP, Anjaneyulu R. Paracervical block with vacuum aspiration. Journal of Obstetrics and Gynaecology of India 1979;29(3):557‐60. [PUBMED: 12335917] - PubMed
Karasahin 2011 {published data only}
    1. Karasahina KM, Alanbaya I, Ercana CM, Mestenb Z, Simsek C, Baser I. Lidocaine spray in addition to paracervical block reduces pain during first‐trimester surgical abortion: a placebo‐controlled clinical trial. Contraception 2011;83:362‐6. [PUBMED: 21397096 ] - PubMed
Kaya 2004 {published data only}
    1. Kaya K, Yalcin Cok O, Ozturk E, Gunaydin B. Effect of premedication on intravenous remifentanil infusion with paracervical block combination for hysteroscopy: Evaluation of preliminary results. Regional Anesthesia and Pain Medicine 2004;29 Suppl 2:94. [DOI: 10.1016/j.rapm.2004.07.209] - DOI
Kun 1999 {published data only}
    1. Kun KY, LO L, Ho MW, Tai CM. A prospective randomized study comparing hysteroscopy and curettage (H & C) under local anaesthesia (LA) and general anaesthesia (GA) in Chinese population. Journal of Obstetrics and Gynaecology Research 1999;25(2):119‐27. [PUBMED: 10379127] - PubMed
Lee 1986 {published data only}
    1. Lee ET, Ozumba EN, Bevan JR. A randomized trial of Citanest with Octapressin for relief of pain associated with laser vaporization of the cervix. British Journal of Obstetrics and Gynaecology 1986;93(9):967‐9. [PUBMED: 2429687] - PubMed
Lee 1998 {published data only}
    1. Lee CC, Martin JS, Newton CR, Tummon IS, Fisher J. Randomised comparison of vaginal versus paracervical xylocaine for oocyte retrieval. Fertility and Sterility 1998;70(3):S345. [CENTRAL: CN‐00224478]
Longhi 1996 {published data only}
    1. Longhi K. Uterine curettage with pudendal and paracervical blocks [Legrado uterino con anestesia regional]. Boletim Medico Postgrado 1996;12(3):52‐8.
Mackay 1985 {published data only}
    1. Mackay HT, Schulz KF, Grimes DA. Safety of local versus general anaesthesia for second‐trimester dilatation and evacuation abortion. Obstetrics and Gynecology 1985;66(5):661‐5. [PUBMED: 4058825] - PubMed
Makris 2001 {published data only}
    1. Makris N, Xygakis A, Dachlythras M, Prevedourakis C, Michalas S. Mepivacaine local cervical anesthesia for diagnostic hysteroscopy: A randomized placebo‐controlled study. Journal of Gynecologic Surgery 2001;17(1):7‐11. [CENTRAL: CN‐00442113; EMBASE: 2001162075]
Manyou 2008 {published data only}
    1. Manyou B, Phupong V. Prospective randomized, double‐blinded, placebo‐controlled trial of preoperative etoricoxib for pain relief in uterine fractional curettage under paracervical block. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2008;140(1):90‐4. [PUBMED: 18396369] - PubMed
Mckenzie 1978 {published data only}
    1. McKenzie R, Shaffer WL. A safer method for paracervical block in therapeutic abortions. American Journal of Obstetrics and Gynecology 1978;130(3):317‐20. [PUBMED: 623172] - PubMed
Mercorio 2002 {published data only}
    1. Mercorio F, Simone R, Landi P, Sarchianaki A, Tessitore G, Nappi C. Oral dexketoprofen for pain treatment during diagnostic hysteroscopy in postmenopausal women. Maturitas 2002;43:277‐81. [PUBMED: 12468136] - PubMed
Moller 1978 {published data only}
    1. Møller BR, Hansen JT, Diederich P, Oram V. Therapeutic abortion in an out‐patient clinic. A prospective investigation of complications and patient acceptability. Acta Obstetricia et Gynecologica Scandinavica 1978;57(1):41‐4. [PUBMED: 622891] - PubMed
Naki 2011 {published data only}
    1. Naki MM, Api O, Acioglu HC, Uzun MG, Kars B, Unal O. Analgesic efficacy of forced coughing versus local anesthesia during cervical punch biopsy. Gynecologic and Obstetic Investigation 2011;72:5‐9. [PUBMED: 21606634] - PubMed
Nielsen 1975 {published data only}
    1. Nielsen JB, Madsen OG, Campbell UD. Diazepam as a sedative in induced abortion. Acta Obstetricia et Gynecologica Scandinavica 1975;54(3):237‐9. [CENTRAL: CN‐00012626; EMBASE: 1976135589; PUBMED: 1099860] - PubMed
Nielsen 1988 {published data only}
    1. Nielsen HK, Klünder K, Møller JT, Werner MU. Midazolam combined with paracervical blockade compared to general anaesthesia for curettage of the uterus. Acta Anaesthesiologica Scandinavia 1988;32:643‐6. [CENTRAL: CN‐00057437; EMBASE: 1989002355; PUBMED: 3063045] - PubMed
O'Neal 2003 {published data only}
    1. O'eal MG, Beste T, Shackelford DP. Utility of preemptive local analgesia in vaginal hysterectomy. American Journal of Obstetrics and Gynecology 2003;189(6):1539‐41. [PUBMED: 14710057 ] - PubMed
Owalabi 2005 {published data only}
    1. Owalabi OT, Moodley J. A randomized trial of pain relief in termination of pregnancy in South Africa. Tropical Doctor 2005;35(3):136‐9. [PUBMED: 16105333] - PubMed
Oyama 2003 {published data only}
    1. Oyama IA, Wakabayashi MT, Frattarelli LC, Kessel B. Local anesthetic reduces the pain of colposcopic biopsies: a randomized trial. American Journal of Obstetrics and Gynecology 2003;188(5):1164‐5. [PUBMED: 12748465] - PubMed
Peretz 1982 {published data only}
    1. Peretz BA, Friedman M, Goldstein I. Curettage by paracervical block associated with intravenous premedication [Curetage par blocage paracervical associe a une premedication intraveineuse]. Revue Française de Gynécologie et d'Obstétrique 1982;77(3):197‐9.
Peters 1978 {published data only}
    1. Peters FD, Hirsch HA. Comparison between intra and paracervical anaesthesia in therapeutic abortion (author's transl). Geburtshilfe und Frauenheilkunde 1978;38(11):946‐9. [PUBMED: 710880] - PubMed
Phair 2002 {published data only}
    1. Phair N, Jensen JT, Nichols MD. Paracervical block and elective abortion: the effect on pain of waiting between injection and procedure. American Journal of Obstetrics and Gynecology 2002;186(6):1304‐7. [PUBMED: 12066113] - PubMed
Phittayawechwiwat 2007 {published data only}
    1. Phittayawechwiwat W, Thanantaseth C, Ayudhya NI, O‐Prasertsawat P, Kongprasert J. Oral etoricoxib for pain relief during fractional curettage: a randomized controlled trial. Journal of the Medical Association of Thailand (Chotmaihet Thangphaet) 2007;90(6):1053‐7. [PUBMED: 17624196] - PubMed
Picton 1968 {published data only}
    1. Picton FC. Paracervical block with bupivacaine. British Medical Journal 1968;2(604):561. [PUBMED: 5749470] - PMC - PubMed
Prest 1976 {published data only}
    1. Prest J, Funck‐Rasmussen L, Olavsgaard P, Jensen JG. Outpatient legal abortion. 500 operations with paracervical anesthesia. Ugeskrift for Laeger 1976;138(6):333‐5. [PUBMED: 1251505] - PubMed
Raeder 1992 {published data only}
    1. Raeder JC. Propofol anaesthesia versus paracervical blockade with alfentanil and midazolam sedation for outpatient abortion. Acta Anaesthesiologica Scandinavica 1992;36:31‐7. [PUBMED: 1539476] - PubMed
Ragab 1978 {published data only}
    1. Ragab MI, Edelman DA, Laufe L. The effects of long acting paracervical block anesthesia on the abortifacient efficacy of intra‐amniotic PGF2alpha and hypertonic saline. Acta Obstetricia et Gynecologica Scandinavica 1978;57(4):327‐31. [PUBMED: 358727] - PubMed
Rattanachaiyanont 2005 {published data only}
    1. Rattanachaiyanont M, Leeasiri P, Indhavivadhana S. Effectiveness of intrauterine anesthesia for pain relief during fractional curettage. Obstetrics and Gynecology 2005;106(3):533‐9. [PUBMED: 16135583] - PubMed
Rogstad 1992 {published data only}
    1. Rogstad KE, White DJ, Ahmed‐Jushuf IH. Efficacy of lignocaine analgesia during treatment to the cervix. Lancet 1992;340(8825):942. [PUBMED: 1357350] - PubMed
Ruoss 1968 {published data only}
    1. Ruoss C, Beazley JM. Paracervical block with bupivacaine. British Medical Journal 1968;2(605):622‐3. [PUBMED: 5658909] - PMC - PubMed
Sammarco 1993 {published data only}
    1. Sammarco MJ, Hartenbach EM, Hunter VJ. Local anesthesia for cryosurgery on the cervix. The Journal of Reproductive Medicine 1993;38(3):170‐2. [PUBMED: 8487231] - PubMed
Scott 1968 {published data only}
    1. Scott DB, Galloway RK, Lees MM, Livingstone JR. Bupivacaine in paracervical block. Proceedings of the Royal Society of Medicine 1968;61(11 Part 1):1158‐9. [PUBMED: 4952985] - PMC - PubMed
Shapiro 1975 {published data only}
    1. Shapiro AG, Cohen H. Auxillary pain relief during suction curettage. Contraception 1975;11(1):25‐30. [PUBMED: 1116357] - PubMed
Stefanidis 1998 {published data only}
    1. Stefanidis K, Paschopoulos M, Dusias B, Adonakis G, Lolis D. A randomized study of local or general anesthesia for laser conization of the cervix. Archives of Gynecology and Obstetrics 1998;261(2):75‐8. [PUBMED: 9544371] - PubMed
Stuart 1993 {published data only}
    1. Stuart GC, Nation JG. Outpatient laser cone biopsy under local anesthesia. Canadian Journal of Surgery. Journal Canadien de Chirurgie 1993;36(1):41‐3. [PUBMED: 8443716] - PubMed
Teramo 1975 {published data only}
    1. Teramo K, Kivalo I, Huovinen K. Obstetric paracervical blockade with etidocaine. Acta Anaesthesiologica Scandinavica. Supplementum 1975;60:100‐5. [PUBMED: 241196] - PubMed
Wallage 2003 {published data only}
    1. Wallage S, Cooper KG, Graham WJ, Parkin DE. A randomised trial comparing local versus general anaesthesia for microwave endometrial ablation. British Journal of Obstetrics and Gynaecology 2003;110(9):799‐807. [CENTRAL: CN‐00440532; PUBMED: 14511961] - PubMed
Whitehouse 1968 {published data only}
    1. Whitehouse DB. Paracervical block with bupivacaine. British Medical Journal 1968;2(607):764. [PUBMED: 5656287] - PMC - PubMed
Wiebe 2005 {published data only}
    1. Wiebe ER, Trouton KJ, Savoy E. Intra‐cervical versus i.v. fentanyl for abortion. Human Reproduction 2005;20(7):2025‐8. [PUBMED: 15831513] - PubMed
Willdeck 1975 {published data only}
    1. Willdeck LG, Zador G. Paracervical block with etidocaine for out‐patient abortion. Acta Anaesthesiologica Scandinavica. Supplementum 1975;60:106‐9. [PUBMED: 1101603] - PubMed
Winkler 1997 {published data only}
    1. Winkler M, Wolters S, Funk A, Rath W. Does para‐cervical block offer additional advantages in abortion induction with gemeprost in the 2nd trimester [Bietet die Parazervikalblockade zusatzliche Vorteile bei der Abortinduktion mit Gemeprost im II trimenon]. Zentralblatt für Gynäkologie 1997;119(12):621‐4. [PUBMED: 9483814] - PubMed
Wong 2002 {published data only}
    1. Wong CY, Ng EH, Ngai SW, Ho PC. A randomized, double blind, placebo‐controlled study to investigate the use of conscious sedation in conjunction with paracervical block for reducing pain in termination of first trimester pregnancy by suction evacuation. Human Reproduction 2002;17(5):1222‐5. [PUBMED: 11980742] - PubMed

References to studies awaiting assessment

Chaudhuri 1980 {published data only}
    1. Chaudhuri P, Drogendijk AC. Open therapeutic evaluation of paracervical infiltration anesthesia with mepivacaine for out‐patients dilatation and curettage. Tijdschrift voor Geneesmiddelenonderzoek 1980;5(4):711‐3. [ISSN:0166‐2384]
Regina 1987 {published data only}
    1. Regina CT, Peruffo GF, Beatriz GL. Efficacy paracervical block in uterine curettage by abortion [Eficacia do bloqueio paracervical em curetagem uterina por abortamento]. Revista da AMRIGS 1987;31(4):262‐4. [ISSN:0102‐2105]
Sen 1980 {published data only}
    1. Sen GS, Das A, Bora L. Evaluation of the efficacy of paracervical block in minor gynaecological operations (a study of 50 cases). The Clinician 1980;44(8):365‐7. [ISSN:0009‐9341]

Additional references

Aimakhu 1972
    1. Aimakhu VE, Ogunbode O. Paracervical block anesthesia for minor gynecologic surgery. International Journal of Gynecology and Obstetrics 1972;10:66‐71.
Amyot‐Legault 1981
    1. Amyot‐Legault A. Systemic use of paracervical block during the insertion of an I.U.D. L'Union Medicale du Canada 1981;110(8):721‐6. [PUBMED: 7292804] - PubMed
Coker 1968
    1. Coker OO. Paracervical block in minor gynaecological operations. The West African Medical Journal and Nigerian Practitioner 1968;17(6):179‐80. [PUBMED: 5703566] - PubMed
Fernandez 1997
    1. Fernandez H, Capella S, Audibert F. Uterine thermal balloon therapy under local anaesthesia for the treatment of menorrhagia: a pilot study. Human Reproduction 1997;12(11):2511‐4. [PUBMED: 9436696] - PubMed
Ferry 1994
    1. Ferry J, Rankin L. Low cost, patient acceptable, local analgesia approach to gynaecological outpatient surgery. A review of 817 consecutive procedures. The Australian & New Zealand Journal of Obstetrics & Gynaecology 1994;34(4):453‐6. [PUBMED: 7848239] - PubMed
Formiga‐Filho 1974
    1. Formiga‐Filho JF, Parente JV, Lago AL. Paracervical anesthesia in dilatation of the cervix. Anestesia Paracervical na Dilatacao do Colo Uterino 1974;20(3‐4):233‐8.
Gad 1967
    1. Gad C. Paracervical block. Acta Obstetricia et Gynecologica Scandinavica 1967;46(7):7‐18. [PUBMED: 6025358] - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analysis. BMJ 2003;327:557‐60. [PUBMED: 12958120] - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lewis 1971
    1. Lewis SC, Lal S, Beard RW, Branch B. Outpatient termination of pregnancy. British Medical Journal 1971;4:606‐10. [PUBMED: 5130219] - PMC - PubMed
Littlepage 1969
    1. Littlepage BN, Daniel DG, Ahmad S, Turnbull AC. Paracervical block anaesthesia for minor gynaecological operations. The Journal of Obstetrics and Gynaecology of the British Commonwealth 1969;76:163‐4. [PUBMED: 5765810] - PubMed
Maltzer 1999
    1. Maltzer DS, Maltzer MC, Wiebe ER, Halvorson‐Boyd G, Boyd C. In: Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG editor(s). A clinician’s guide to medical and surgical abortion. Philadelphia PA: Churchill Livingstone, 1999:73‐89.
Piyamongkol 1998
    1. Piyamongkol W. Obstetrics [Obstetric anaesthesiology]. In: Tongsong T, Wanapirak C,editor(s). 4th Edition. Bangkok: P.B. Foreign Book Center, 1998:155‐68.
Readman 2004
    1. Readmen E, Maher PJ. Pain relief and outpatient hysteroscopy: a literature review. The Journal of the American Association of Gynecologic Laparoscopists 2004;11(3):315‐9. [PUBMED: 15559340] - PubMed
Reguer Noriega 1973
    1. Reguer Noriega A. Pericervical block in curettage of the uterus [Bloqueo pericervical en al legrado uterino]. Ginecología y Obstetricia de México 1973;34(202):95‐102. [PUBMED: 4753793] - PubMed
RevMan 5.1 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan).Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Rotchell 1976
    1. Rotchell YE. An evaluation of paracervical block anaesthesia for use in minor gynaecological surgery. The West Indian Medical Journal 1976;25(1):35‐8. [PUBMED: 1266208] - PubMed
Sandmire 1974
    1. Sandmire HF, Austin SD. Curettage as an office procedure. American Journal of Obstetrics and Gynecology 1974;119(1):82‐8. [PUBMED: 4820913] - PubMed
Santonja 1974
    1. Santonja J, Andreu E, Bonilla MF. Paracervical anaesthesia in gynecology [LA anestesia paracervical en ginecologia]. Revista Española de Obstetricia y Ginecología 1974;33(194):142‐5.
Scott 1976
    1. Scott J, Huskisson EC. Graphic representation of pain. Pain 1976;2:175‐84. [PUBMED: 1026900] - PubMed
Smith 1991
    1. Smith RP, Heltzel JA. Interrelation of analgesia and uterine activity in women with primary dysmenorrhea. A preliminary report. Journal of Reproductive Medicine 1991;36:260‐4. [PUBMED: 2072357] - PubMed
Strausz 1971
    1. Strausz IK, Schulman H. 500 outpatient abortions performed under local anesthesia. Obstetrics and Gynecology 1971;38(2):199‐205. [PUBMED: 5560101] - PubMed
Thonneau 1998
    1. Thonneau P, Fougeyrollas B, Ducot B, Boubilley D, Dif J, Lalande M, et al. Complications of abortion performed under local anesthesia. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1998;81:59‐63. [PUBMED: 9846716] - PubMed
Toth 2000
    1. Tóth D, Kuzel D, Parízek A, Fucíková Z, Zivný J, Marusicová P, et al. Paracervical anesthesia in hysteroscopy and transcervical surgery. Ceská Gynekologie / Ceská lékarská spolecnost J. Ev. Purkyne 2000;65(1):42‐5. [PUBMED: 10750297] - PubMed
Van Praagh 1967
    1. Praagh IG, Povey WG. Paracervical block anesthesia for dilatation and curettage. Obstetrics and Gynecology 1967;29(2):167‐9. [PUBMED: 6018161] - PubMed
Walden 1973
    1. Walden WD. Modified cervical block for elective abortion procedures. Obstetrics and Gynecology 1973;41(3):473‐4. [PUBMED: 4688267] - PubMed

References to other published versions of this review

Tangsiriwatthana 2009
    1. Tangsiriwatthana T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD005056.pub2] - DOI - PubMed

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