Can lidocaine gel replace paracervical block for gyn procedures?

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

Related ObG Topics:

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