• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Can lidocaine gel replace paracervical block for gyn procedures?

image_pdfFavoriteLoadingFavorite

FINDINGS: 

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)

SYNOPSIS:

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.

KEY POINTS:

  • 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

Learn More – Primary Sources:

Self-Administered Lidocaine Gel for Pain Control with First-Trimester Surgical Abortion

image_pdfFavoriteLoadingFavorite

< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Levels of Evidence – How to Rate the Quality of a Study

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Download Your ObG App
HERE!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site