Paracervical block

A paracervical block is an anesthetic procedure used in obstetrics and gynecology, in which a local anesthetic is injected into between two and six sites at a depth of 3–7 mm alongside the vaginal portion of the cervix in the vaginal fornices. In the United States, the paracervical block is underutilized during insertion of intrauterine devices (IUDs). There is speculation that this is related to the disproportionate under-researching of women's health.

It is used for various obstetric and gynecologic procedures, such as hysteroscopy and vacuum aspiration. It is as efficient as intracervical block, according to a study on women undergoing vacuum aspiration with lidocaine as anesthetic agent.

The majority of surgical abortions in the United States are performed with a paracervical block with or without the addition of other pain medications. The best specific technique has yet to be defined and there is still a lot of procedure-related pain. The choice of the best anesthesia depends on patient preference and resources available.

In addition, a paracervical block may be performed by a wide variety of clinicians including family medicine physicians, OB/GYNs, advanced practitioners, certified nurse midwives, and RNs.

Addition of ketorolac may offer added benefit of improved pain control.

References

  1. ↑ paracervical block Archived 2011-07-28 at the Wayback Machine By Robert Nadelberg. Copyright 2007 by Boston Scientific Corporation
  2. ↑ Murai, Ruth. "Why haven't we figured out how to make IUDs less excruciating?". Mother Jones. Retrieved 2023-01-18.
  3. ↑ Mankowski, J.; Kingston, J.; Moran, T.; Nager, C.; Lukacz, E. (2009). "Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial". Obstetrics and Gynecology. 113 (5): 1052–1057. doi:10.1097/AOG.0b013e31819ec97e. PMID 19384120. S2CID 25650472.
  4. 1 2 Crouthamel, Bonnie; Economou, Nicole; Averbach, Sarah; Rible, Radhika; Kully, Gennifer; Meckstroth, Karen; Mody, Sheila K. (August 2022). "Effect of Paracervical Block Volume on Pain Control for Dilation and Aspiration: A Randomized Controlled Trial". Obstetrics & Gynecology. 140 (2): 234–242. doi:10.1097/AOG.0000000000004862. ISSN 0029-7844. PMID 35852274.
  5. ↑ "Paracervical block". Ipas. Retrieved 2024-04-15.
  6. ↑ Cansino, Catherine; Edelman, Alison; Burke, Anne; Jamshidi, Roxanne (December 2009). "Paracervical Block With Combined Ketorolac and Lidocaine in First-Trimester Surgical Abortion: A Randomized Controlled Trial". Obstetrics & Gynecology. 114 (6): 1220–1226. doi:10.1097/AOG.0b013e3181c1a55b. ISSN 0029-7844. PMID 19935022. S2CID 22458136.

Further reading