A study comparing paracervical block with procedural sedation in the surgical management of incomplete/missed miscarriages

Master Thesis


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University of Cape Town

Objective: To compare the analgesic efficacy of Paracervical Block (1% lidocaine) with procedural sedation (Midazolam/Fentanyl) in the surgical management of incomplete/ missed miscarriages. Study design: An efficacy trial with a naturally occurring control group who received what is standard practice. The study compared two methods of analgesia. The study group received paracervical block and the control group received procedural sedation. The study ran over two consecutive months (December 2012/January 2013). Setting: Groote Schuur Hospital, a level three hospital situated in Cape Town, South Africa. Population: All women between 18 and 55 years of age that were admitted to Groote Schuur Hospital requiring a uterine evacuation following either a spontaneous incomplete or a missed miscarriage that were not excluded by any of the exclusion criteria. Methods: Over the two month period recruited participants (those patients who fit the inclusion criteria and were agreeable to participate) were allocated to either the control group (month 1) or the intervention group (month 2), depending on which month they had the uterine evacuation. Data was collected from the uterine evacuations of the recruited participants over the two month study period. Main outcome measure: The participants perceived pain during and after uterine evacuation (10 minutes and two hours), scored by the participant on an eleven point numerical pain scale. Secondary outcomes were the surgeons’ satisfaction with the analgesia, duration of procedure and complications/ side effects of the two methods of analgesia under study. Results: A total of 111 participants were recruited over the study period, 57 in the control group and 54 in the intervention group. The average pain score during the procedure was lower in the Paracervical block group compared with the procedural sedation group, but this difference was not statistically significant at a 5% level (t=-1.8495, p=0.0671). For the Paracervical block group, the ‘’pain during” mean and the standard deviation (SD) were 5.56 and 2.50 respectively, whilst for the Procedural sedation group, the mean and SD were 6.49 and 2.81 respectively. Conclusion: Paracervical block using 1% lidocaine is an effective and safe alternative to procedural sedation in the surgical management of incomplete/missed miscarriages.

Includes bibliographical references.