Local anaesthesia for pain control in surgical abortion before 14 weeks of pregnancy: a systematic review.

IF 3.4 3区 医学 Q1 FAMILY STUDIES BMJ Sexual & Reproductive Health Pub Date : 2024-08-29 DOI:10.1136/bmjsrh-2024-202437
Regina Renner, Madeleine Ennis, Adrienne McKercher, Jillian T Henderson, Alison Edelman
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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.

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妊娠 14 周前手术流产中局部麻醉止痛:系统综述。
背景:人工流产很常见,并伴有手术疼痛。我们旨在评估在妊娠不足 14 周的手术流产过程中为控制疼痛而进行局部麻醉的益处和害处:我们检索了一篇系统性综述,内容涉及妊娠小于 14 周时使用子宫吸引术进行手术流产时为控制疼痛而进行的局部麻醉。我们检索了 2022 年 12 月之前的多个数据库。我们使用 Cochrane Risk of Bias 2 (RoB2) 工具评估了研究质量,并使用 GRADE(推荐评估、发展和评价分级)评估了证据的确定性。研究结果包括术中疼痛(扩张、抽吸或手术)、患者满意度和不良事件:有 13 项研究(1992 人参与)符合纳入标准,大多数研究被判定为偏倚风险较低。干预方案各不相同,限制了荟萃分析。20毫升1%利多卡因宫颈旁阻滞(PCB)与假PCB(平均差(MD)-37.00,95% CI -45.64至-28.36)和抽吸(MD -26.00,95% CI -33.48至-18.52;1项随机对照试验(RCT),n=120;高确定性证据)相比,可减少扩张时的疼痛。与在两个或四个部位注射生理盐水PCB相比,注射14毫升1%氯普鲁卡因的PCB可轻微减轻抽吸过程中的疼痛(MD -1.50,95% CI -2.45至-0.55;1项随机对照试验,n=79;高确定性证据)。其他 RCT 比较了一系列局麻药类型、PCB 技术和局部麻醉药。参与者对任何类型疼痛控制的满意度都中等偏上,研究报告的不良事件很少,很少与药物有关:RCT证据支持多氯联苯的疗效,但不一致,且局部麻醉的确定性较低。
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来源期刊
BMJ Sexual & Reproductive Health
BMJ Sexual & Reproductive Health Medicine-Reproductive Medicine
CiteScore
5.10
自引率
6.10%
发文量
38
期刊介绍: BMJ Sexual & Reproductive Health is a multiprofessional journal that promotes sexual and reproductive health and wellbeing, and best contraceptive practice, worldwide. It publishes research, debate and comment to inform policy and practice, and recognises the importance of professional-patient partnership.
期刊最新文献
Shifting discourses, changing interests? How the language of sexual and reproductive health has evolved in the past 50 years. "That's not how abortions happen": a qualitative study exploring how young adults navigate abortion misinformation in the post-Roe era. Attitudes towards the regulation and provision of abortion among healthcare professionals in Britain: cross-sectional survey data from the SACHA Study. Reported side effects from hormonal contraceptives among those seeking abortion care versus contraceptive services. The post-Roe potential of mifepristone and misoprostol in the United States.
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