Lidocaine and Pain Management in First Trimester Abortions

Study Overview
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Brief Summary
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The purpose of this study is to examine the effect of lidocaine (a numbing medication) inside the uterus on patient pain during an early abortion, compared to the paracervical block (lidocaine injected on either side of the cervix).

Detailed Description
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The Investigators intend to conduct a randomized, patient-blinded control trial at Oregon Health and Science University and Planned Parenthood of the Columbia Willamette. Women will be approached about this study after they have made a decision to terminate the pregnancy. The women will be blinded and randomized into one of two study arms. Group 1: the investigator will apply pressure with the capped needle of the paracervical block at the cervical-vaginal reflexion at 4 and 8 o'clock. This will approximate the steps involved in a paracervical block without injecting the patient. Following this, the patient will receive a 5 milliliter intrauterine infusion of 4% lidocaine using a sterile 3mm Novak curette. The infusion will be placed slowly over 3 minutes. Group 2: a standard paracervical block (8 milliliter 1% lidocaine at 4 and 8 o'clock at the cervical-vaginal reflection) will be placed. Following this, a 3 mm Novak curette will be placed in the vagina and held to the external os of the cervix for 3 minutes. The curette will not be placed through the cervix and no infusion will be performed. This will approximate the steps involved in an intrauterine infusion without injecting the patient. During the procedure, women in both groups will be asked to rate their pain at various times using a 10 cm visual analog scale (VAS).

Official Title
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A Comparison of Intrauterine Lidocaine Infusion and Paracervical Block for Pain Management in First Trimester Abortions

Conditions
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Pain

Intervention / Treatment
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* Drug: Lidocaine
* Drug: Lidocaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Good general health Age>18years English speaking Voluntarily requesting pregnancy termination Have an estimated gestation of up to 76 days since the first day of the preceding menstrual period Confirmed by ultrasound Be able and willing to sign an informed consent Agree to the terms of the study All patients must be premedicated with Ibuprofen and Valium (per clinic protocols) Exclusion Criteria: Significant physical or mental health condition A gestational age of 77 days or more Adnexal mass or tenderness on pelvic exam consistent with pelvic inflammatory disease Patients who require or request IV/intramuscular sedation Patients who refuse Ibuprofen, Valium and/or paracervical blocks Patients allergic to lidocaine Patients with known hepatic disease Patients weighing less than 100 lbs

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lidocaine infusion<br>5 milliliter intrauterine infusion of 4% lidocaine, infusion will be placed slowly over 3 minutes. | Drug: Lidocaine<br>* 5 milliliter intrauterine infusion of 4% lidocaine, infusion will be placed slowly over 3 minutes.<br>|
| Active Comparator: Paracervical block only<br>Standard paracervical block (8 milliliter 1% lidocaine at 4 and 8 o'clock at the cervical-vaginal reflection) will be placed. | Drug: Lidocaine<br>* Standard paracervical block (8 milliliter 1% lidocaine at 4 and 8 o'clock at the cervical-vaginal reflection) will be placed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Effects of an Intrauterine Lidocaine Infusion to Standard Paracervical Block on Decreasing Patient Pain Measured by Visual Analog Scale in First Trimester Abortions. | Subjects perception of pain is measured using a 100mm visual analog scale (VAS).The 100mm Pain Visual Analog Scale (VAS) is an instrument used to capture subjective attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of pain by indicating a position along a 100mm continues line: pain scores can range from 0 (no pain) to 100 (worst pain imaginable). | Immediately (time zero) at uterine aspiration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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surgical abortion, pain management