Can lidocaine gel replace paracervical block for gyn procedures?
A randomized controlled trial (Conti et al, Obstet Gynecol 2016) was designed to compare pain control during first-trimester surgical abortion using self-administered lidocaine gel versus traditional paracervical block. The authors found that when comparing the gel to the block
There were no differences in pain scores for (1) tenaculum placement, (2) cervical dilation or (3) postprocedure pain
Total procedure time was shorter in the self-administered lidocaine gel group (5:23 minutes) compared to the paracervical block group (7:16 minutes), and was statistically significant (P=.000)
More women in the lidocaine gel group (15.9%) requested or received additional IV medication compared to the paracervical block group (5.9%), but this was not statistically significant (P=.10)
The authors enrolled 142 women into this study, with 137 included in the analysis. The lidocaine gel group self-administered 20mL of a 2% lidocaine gel vaginally (400 mg total) 20-30 minutes prior to the procedure using a 20-mL sterile, Luer-lock syringe. The control group received a paracervical block using 12 mL of 1% lidocaine (120 mg) using a 22g needle, injecting 2 mL at the tenaculum site with immediate tenaculum placement. Then 5 mL was injected at 4 o’clock and the remaining 5 mL at 8 o’clock along the cervicovaginal junction. All patients received 100 mg IV fentanyl and 1 mg IV midazolam before speculum insertion.
The authors used a visual 100-mm pain scale from 0 mm (no pain) to 100 mm (worst pain imaginable)
The mean pain score for cervical dilation was 64 mm in the lidocaine gel group and 60 mm in the paracervical block group which was not statistically different
The authors note a cost difference of $11 for the gel versus $621 for the block (injection and professional fees)
A limitation of the study is the use of 10 mL vs. 20 mL of lidocaine for paracervical block; however, the authors note there is no evidence that 20 mL is more effective and 10 mL is often used
The authors are conducting further studies looking at the use of self-administered lidocaine gel for other gyn procedures such as IUD or endometrial biopsy procedures
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