A Cochrane review [Abstract] 1 included 16 studies with a total of 2235 subjects. Data were insufficient to show a clear benefit of a paracervical block (PCB) compared to no PCB or a PCB with bacteriostatic saline. Pain scores (data from 11-point visual or verbal pain scales was treated as continuous data to allow comparisons to 10 cm scales) during dilation and aspiration were improved with deep injection (WMD -1.64 95% CI -3.21 to -0.08; WMD 1.00 95% CI 1.09 to 0.91; 2 trials, n=229), and with adding a 4% intrauterine lidocaine infusion (WMD -2.0 95% CI -3.29 to -0.71, WMD -2.8 95% CI -3.95 to -1.65 with dilation and aspiration respectively). Ibuprofen (1 study) and naproxen (1 study) resulted in small reduction of intra- and post-operative pain. The addition of conscious intravenous sedation using diazepam and fentanyl to PCB decreased procedural pain.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment in some studies), by inconsistency (variability in results across studies), and by imprecise results (limited study size for each comparison).
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