Cochrane · systematic review · CD006712
Local anaesthesia for pain control in first trimester surgical abortion
Renner, R-M, Ennis, M, McKercher, AE, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
Fertility RegulationAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
57
current version
GRADE rated
29
No studies
28
Included studies
NR
No studies 28 · 49.1%Ungraded 0 · 0%Very low 3 · 5.3%Low 10 · 17.5%Moderate 12 · 21.1%High 4 · 7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings table ‐ 20 mL 1% lidocaine paracervical block compared to sham paracervical block for people requesting a surgical abortion at less than 11 weeks? gestation
Population: people requesting a surgical abortion at less than 11 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilationa,b Summary of findings table ‐ 20 mL 1% lidocaine paracervical block vs sham paracervical block | no estimate extracted | 1 study · 120 participants | High |
Pain with aspirationa,b Summary of findings table ‐ 20 mL 1% lidocaine paracervical block vs sham paracervical block | no estimate extracted | 1 study · 120 participants | High |
Pain during procedure ‐ not measured Summary of findings table ‐ 20 mL 1% lidocaine paracervical block vs sham paracervical block | no estimate extracted | NR | No studies |
Summary of findings table ‐ 20 mL 1% lidocaine paracervical block compared to normal saline paracervical block for people requesting a surgical abortion at less than 14 weeks' gestation
Population: people requesting a surgical abortion at less than 14 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilationa,b Summary of findings table ‐ 20 mL 1% lidocaine paracervical block vs normal saline paracervical block | no estimate extracted | 1 study · 150 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Pain with aspirationa,b Summary of findings table ‐ 20 mL 1% lidocaine paracervical block vs normal saline paracervical block | no estimate extracted | 1 study · 150 participants | Low Downgraded: risk of bias, inconsistency |
Pain during procedure ‐ not measured Summary of findings table ‐ 20 mL 1% lidocaine paracervical block vs normal saline paracervical block | no estimate extracted | NR | No studies |
Summary of findings table ‐ 80 mg lidocaine paracervical block compared to normal saline paracervical block for people requesting a surgical abortion at seven weeks' gestation or less
Population: people requesting a surgical abortion at seven weeks' gestation or less
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ 80 mg lidocaine paracervical block vs normal saline paracervical block | no estimate extracted | NR | No studies |
Pain with aspiration ‐ not measured Summary of findings table ‐ 80 mg lidocaine paracervical block vs normal saline paracervical block | no estimate extracted | NR | No studies |
Pain during procedurea,b Summary of findings table ‐ 80 mg lidocaine paracervical block vs normal saline paracervical block | no estimate extracted | 1 study · 54 participants | Moderate Downgraded: indirectness |
Pain during procedure in women who also received topical cervical lidocaine spraya,b Summary of findings table ‐ 80 mg lidocaine paracervical block vs normal saline paracervical block | no estimate extracted | 1 study · 54 participants | Moderate Downgraded: indirectness |
Summary of findings table ‐ 14 mL 1% chloroprocaine paracervical block compared to normal saline paracervical block for women requesting a surgical abortion at seven to 12 weeks of gestation
Population: women requesting a surgical abortion at seven to 12 weeks of gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ 14 mL 1% chloroprocaine paracervical block vs normal saline paracervical block | no estimate extracted | NR | No studies |
Pain with aspirationa,b Summary of findings table ‐ 14 mL 1% chloroprocaine paracervical block vs normal saline paracervical block | no estimate extracted | 1 study · 79 participants | High |
Pain during procedure ‐ not measured Summary of findings table ‐ 14 mL 1% chloroprocaine paracervical block vs normal saline paracervical block | no estimate extracted | NR | No studies |
Summary of findings table ‐ Ultracaine paracervical block compared to placebo (normal saline) paracervical block/no paracervical block for people requesting a surgical abortion at 5+0 to 7+0 weeks' gestation
Population: people requesting a surgical abortion at 5+0 to 7+0 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ Ultracaine paracervical block vs placebo (normal saline) paracervical block/no paracervical block | no estimate extracted | NR | No studies |
Pain with aspiration ‐ not measured Summary of findings table ‐ Ultracaine paracervical block vs placebo (normal saline) paracervical block/no paracervical block | no estimate extracted | NR | No studies |
Pain during procedurea,b Summary of findings table ‐ Ultracaine paracervical block vs placebo (normal saline) paracervical block/no paracervical block | no estimate extracted | 1 study · 43 participants | Low Downgraded: risk of bias, inconsistency, indirectness |
Summary of findings table ‐ Topical cervical lidocaine spray compared to ultracaine paracervical block for people requesting a surgical abortion at 5+0 to 7+0 weeks' gestation
Population: people requesting a surgical abortion at 5+0 to 7+0 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ Topical cervical lidocaine spray vs ultracaine paracervical block | no estimate extracted | NR | No studies |
Pain with aspiration ‐ not measured Summary of findings table ‐ Topical cervical lidocaine spray vs ultracaine paracervical block | no estimate extracted | NR | No studies |
Pain during procedurea,b Summary of findings table ‐ Topical cervical lidocaine spray vs ultracaine paracervical block | no estimate extracted | 1 study · 48 participants | Moderate Downgraded: indirectness |
Summary of findings table ‐ Intravenous paracetamol compared to ultracaine paracervical block for people requesting a surgical abortion at 5+0 to 7+0 weeks? gestation
Population: people requesting a surgical abortion at 5+0 to 7+0 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ Intravenous paracetamol vs ultracaine paracervical block | no estimate extracted | NR | No studies |
Pain with aspiration ‐ not measured Summary of findings table ‐ Intravenous paracetamol vs ultracaine paracervical block | no estimate extracted | NR | No studies |
Pain during procedurea,b Summary of findings table ‐ Intravenous paracetamol vs ultracaine paracervical block | no estimate extracted | 1 study · 46 participants | Moderate Downgraded: indirectness |
Summary of findings table ‐ Buffered lidocaine compared to plain lidocaine for people requesting a surgical abortion at 13+6 weeks? gestation or less (Chin 2020 included people experiencing an early pregnancy loss)
Population: people requesting a surgical abortion at 13+6 weeks' gestation or less (Chin 2020 included people experiencing an early pregnancy loss)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation (10 mL 2% lidocaine)a,b Summary of findings table ‐ Buffered lidocaine vs plain lidocaine | no estimate extracted | 1 study · 167 participants | Moderate Downgraded: risk of bias |
Pain with dilation (20 mL 1% lidocaine)d,e Summary of findings table ‐ Buffered lidocaine vs plain lidocaine | no estimate extracted | 1 study · 98 participants | Low Downgraded: imprecision |
Pain with aspiration (lidocaine)a,b Summary of findings table ‐ Buffered lidocaine vs plain lidocaine | no estimate extracted | 2 studies · 291 participants | Moderate Downgraded: risk of bias |
Pain with aspiration (20 mL 1% lidocaine)d,e Summary of findings table ‐ Buffered lidocaine vs plain lidocaine | no estimate extracted | 1 study · 98 participants | Low Downgraded: imprecision |
Summary of findings table ‐ 20 mL 1% plain lidocaine compared to 20 mL 0.25% bupivacaine for people requesting a surgical abortion in the first trimester
Population: people requesting a surgical abortion in the first trimester
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with aspirationa,b Summary of findings table ‐ 20 mL 1% plain lidocaine vs 20 mL 0.25% bupivacaine | no estimate extracted | 1 study · 143 participants | Low Downgraded: risk of bias, imprecision |
Pain with dilation ‐ not measured Summary of findings table ‐ 20 mL 1% plain lidocaine vs 20 mL 0.25% bupivacaine | no estimate extracted | NR | No studies |
Pain during procedure ‐ not measured Summary of findings table ‐ 20 mL 1% plain lidocaine vs 20 mL 0.25% bupivacaine | no estimate extracted | NR | No studies |
Summary of findings table ‐ 20 mL 1% buffered lidocaine compared to 20 mL 0.25% bupivacaine for people requesting a surgical abortion in the first trimester
Population: people requesting a surgical abortion in the first trimester
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ 20 mL 1% buffered lidocaine vs 20 mL 0.25% bupivacaine | no estimate extracted | NR | No studies |
Pain with aspirationa,b Summary of findings table ‐ 20 mL 1% buffered lidocaine vs 20 mL 0.25% bupivacaine | no estimate extracted | 1 study · 133 participants | Moderate Downgraded: risk of bias |
Pain during procedure ‐ not measured Summary of findings table ‐ 20 mL 1% buffered lidocaine vs 20 mL 0.25% bupivacaine | no estimate extracted | NR | No studies |
Summary of findings table ‐ 20 mL 1% lidocaine compared to 20 mL 0.5% lidocaine for people requesting a surgical abortion between seven and 14 weeks? gestation
Population: people requesting a surgical abortion between seven and 14 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ 20 mL 1% lidocaine vs 20 mL 0.5% lidocaine | no estimate extracted | NR | No studies |
Pain with aspirationa,b Summary of findings table ‐ 20 mL 1% lidocaine vs 20 mL 0.5% lidocaine | no estimate extracted | 1 study · 209 participants | Very low Downgraded: risk of bias, imprecision |
Pain during procedure ‐ not measured Summary of findings table ‐ 20 mL 1% lidocaine vs 20 mL 0.5% lidocaine | no estimate extracted | NR | No studies |
Summary of findings table ‐ Three‐ to five‐minute wait between paracervical block injection and cervical dilation compared to no wait between paracervical block injection and cervical dilation for people requesting a surgical abortion at less than 11 weeks? gestation
Population: people requesting a surgical abortion at less than 11 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilationa,b Summary of findings table ‐ Three‐ to five‐minute wait between paracervical block injection and cervical dilation vs no wait between paracervical block injection and cervical dilation | no estimate extracted | 2 studies · 357 participants | Moderate Downgraded: risk of bias, inconsistency |
Pain with aspirationa,b Summary of findings table ‐ Three‐ to five‐minute wait between paracervical block injection and cervical dilation vs no wait between paracervical block injection and cervical dilation | no estimate extracted | 2 studies · 357 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Pain during procedure ‐ not measured Summary of findings table ‐ Three‐ to five‐minute wait between paracervical block injection and cervical dilation vs no wait between paracervical block injection and cervical dilation | no estimate extracted | NR | No studies |
Summary of findings table ‐ 10 mL 2% cervical lignocaine gel compared to 10 mL cervical KY jelly for women requesting a surgical abortion between seven and 12 weeks' gestation
Population: women requesting a surgical abortion between seven and 12 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilationa,b Summary of findings table ‐ 10 mL 2% cervical lignocaine gel vs 10 mL cervical KY jelly | no estimate extracted | 1 study · 131 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Pain with aspirationa,b Summary of findings table ‐ 10 mL 2% cervical lignocaine gel vs 10 mL cervical KY jelly | no estimate extracted | 1 study · 131 participants | Moderate Downgraded: risk of bias, inconsistency |
Pain during procedure ‐ not measured Summary of findings table ‐ 10 mL 2% cervical lignocaine gel vs 10 mL cervical KY jelly | no estimate extracted | NR | No studies |
Summary of findings table ‐ Two pumps of 10% cervical lidocaine spray and paracervical block compared to two pumps of cervical normal saline spray and paracervical block for people requesting a surgical abortion at seven weeks' gestation or less
Population: people requesting a surgical abortion at seven weeks' gestation or less
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ Two pumps of 10% cervical lidocaine spray and paracervical block vs two pumps of cervical normal saline spray and paracervical block | no estimate extracted | NR | No studies |
Pain with aspiration ‐ not measured Summary of findings table ‐ Two pumps of 10% cervical lidocaine spray and paracervical block vs two pumps of cervical normal saline spray and paracervical block | no estimate extracted | NR | No studies |
Pain during procedurea,b Summary of findings table ‐ Two pumps of 10% cervical lidocaine spray and paracervical block vs two pumps of cervical normal saline spray and paracervical block | no estimate extracted | 1 study · 54 participants | Moderate Downgraded: indirectness |
Summary of findings table ‐ Two puffs of cervical lidocaine spray compared to placebo cervical spray/no spray for people requesting a surgical abortion at 5+0 to 7+0 weeks? gestation
Population: people requesting a surgical abortion at 5+0 to 7+0 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ Two puffs of cervical lidocaine spray vs placebo cervical spray/no spray | no estimate extracted | NR | No studies |
Pain with aspiration ‐ not measured Summary of findings table ‐ Two puffs of cervical lidocaine spray vs placebo cervical spray/no spray | no estimate extracted | NR | No studies |
Pain during procedurea,b Summary of findings table ‐ Two puffs of cervical lidocaine spray vs placebo cervical spray/no spray | no estimate extracted | 1 study · 45 participants | Low Downgraded: risk of bias, inconsistency, indirectness |
Summary of findings table ‐ 3 cm deep paracervical block compared to 1.5 cm deep paracervical block for people requesting a surgical abortion at less than 12 weeks? gestation (Cetin 1997) and in the first trimester (Wiebe 1992)
Population: people requesting a surgical abortion at less than 12 weeks' gestation (Cetin 1997) and in the first trimester (Wiebe 1992)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilationa,b Summary of findings table ‐ 3 cm deep paracervical block vs 1.5 cm deep paracervical block | no estimate extracted | 2 studies · 229 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Pain with aspirationa,b Summary of findings table ‐ 3 cm deep paracervical block vs 1.5 cm deep paracervical block | no estimate extracted | 2 studies · 229 participants | Low Downgraded: risk of bias, imprecision |
Pain during procedure ‐ not measured Summary of findings table ‐ 3 cm deep paracervical block vs 1.5 cm deep paracervical block | no estimate extracted | NR | No studies |
Summary of findings table ‐ 2 site (4‐8 o?clock) paracervical block compared to 4 site (2‐4‐8‐10 o?clock) paracervical block for people requesting a surgical abortion at less than 11 weeks? gestation (Renner 2016) and seven to 12 weeks? gestation (Glantz 2001)
Population: people requesting a surgical abortion at less than 11 weeks' gestation (Renner 2016) and seven to 12 weeks' gestation (Glantz 2001)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilationa,b Summary of findings table ‐ 2 site (4‐8 o?clock) paracervical block vs 4 site (2‐4‐8‐10 o?clock) paracervical block | no estimate extracted | 1 study · 163 participants | High |
Pain with aspiration – normal salined,e Summary of findings table ‐ 2 site (4‐8 o?clock) paracervical block vs 4 site (2‐4‐8‐10 o?clock) paracervical block | no estimate extracted | 1 study · 41 participants | Moderate Downgraded: imprecision |
Pain with aspiration – local anaesthetica,b,d,e Summary of findings table ‐ 2 site (4‐8 o?clock) paracervical block vs 4 site (2‐4‐8‐10 o?clock) paracervical block | no estimate extracted | 2 studies · 201 participants | Moderate Downgraded: imprecision |
Pain during procedure ‐ not measured Summary of findings table ‐ 2 site (4‐8 o?clock) paracervical block vs 4 site (2‐4‐8‐10 o?clock) paracervical block | no estimate extracted | NR | No studies |
Summary of findings table ‐ Intravenous paracetamol 1000 mg compared to 2 pumps of cervical lidocaine spray for people requesting a surgical abortion at 5+0 to 7+0 weeks? gestation
Population: people requesting a surgical abortion at 5+0 to 7+0 weeks' gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain with dilation ‐ not measured Summary of findings table ‐ Intravenous paracetamol 1000 mg vs 2 pumps of cervical lidocaine spray | no estimate extracted | NR | No studies |
Pain with aspiration ‐ not measured Summary of findings table ‐ Intravenous paracetamol 1000 mg vs 2 pumps of cervical lidocaine spray | no estimate extracted | NR | No studies |
Pain during procedurea,b Summary of findings table ‐ Intravenous paracetamol 1000 mg vs 2 pumps of cervical lidocaine spray | no estimate extracted | 1 study · 48 participants | Low Downgraded: imprecision, indirectness |