Article Text
Abstract
Background Abortions are common and associated with procedural pain. We aimed to evaluate benefits and harms of local anaesthesia given for pain control during surgical abortion at less than 14 weeks' gestation.
Methods We searched a systematic review on local anaesthesia for pain control for surgical abortion at less than 14 weeks' gestation using uterine aspiration. We searched multiple databases through December 2022. We evaluated study quality using the Cochrane Risk of Bias 2 (RoB2) instrument and assessed the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Outcomes included intraoperative pain (with dilation, aspiration or procedure), patient satisfaction and adverse events.
Results Thirteen studies with 1992 participants met the inclusion criteria and the majority were judged as low risk of bias. Intervention protocols were heterogeneous, limiting meta-analysis. A 20 mL 1% lidocaine paracervical block (PCB) reduced pain with dilation compared with sham PCB (mean difference (MD) −37.00, 95% CI −45.64 to −28.36) and aspiration (MD −26.00, 95% CI −33.48 to −18.52; 1 randomised controlled trial (RCT), n=120; high-certainty evidence). A PCB with 14 mL 1% chloroprocaine was associated with a slight reduction in pain during aspiration compared with normal saline PCB injected at two or four sites (MD −1.50, 95% CI −2.45 to −0.55; 1 RCT, n=79; high-certainty evidence). Other RCTs compared a range of local anaesthetic types, PCB techniques and topical anaesthetics. Participants reported moderately high satisfaction with any type of pain control and studies reported few adverse events that were rarely medication-related.
Conclusion RCT evidence supports PCB efficacy but was inconsistent and of low certainty for topical anaesthesia.
- abortion, induced
- family planning services
- Patient Satisfaction
- Reproductive Health Services
Data availability statement
No data are available. Not applicable.
Statistics from Altmetric.com
Data availability statement
No data are available. Not applicable.
Footnotes
Contributors RR and AE initiated the review update. RR, ME, AMK and AE screened and selected the studies. All authors made risk of bias judgements. RR, ME, AMK and AE extracted data. ME and AMK entered data into Review Manager 5. RR checked all study characteristics for accuracy against the trial reports. RR, ME and AMK performed the meta-analysis. RR, ME and JTH conducted the GRADE assessment. RR, ME and AMK drafted the review. All authors helped resolve discrepancies and approved the final version of the review. RR acted as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests RR has been involved with several studies included in this review. These studies did not receive pharmaceutical funding. ME: none. AMK: none. JTH: none. AE has been involved with several studies included in this review. These studies did not receive pharmaceutical funding.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.