Randomised clinical trial comparing lignocaine paracervical block and placebo for pain management during manual vacuum aspiration for incomplete abortion at Kenyatta national hospital

Abstract

Introduction: One of the most important aspects in treating incomplete abortion is the sufficient management of pain during the process of evacuating the uterus using manual vacuum aspiration (MVA). There is a broad spectrum of pain management, but this study was determining the effectiveness of lignocaine as a paracervical block during manual vacuum aspiration. Objectives: To determine the effectiveness of lignocaine 1% paracervical block in controlling pain among women treated with manual vacuum aspiration for incomplete abortion . Methods: A randomized clinical trial was conducted at Kenyatta National Hospital acute gynaecology at the accident and emergency centre (A&E) involving patients with incomplete abortion. The sample size was calculated using the power of 80% and 95%(CI). The lignocaine group were 126 and the placebo group were 126. Women who met the eligibility criteria were recruited to participate in the study. They were randomly assigned to receive either paracervical block using 1% lignocaine or paracervical block of normal saline as the placebo. Patients with active infection e.g. purulent discharge, severe illness, or allergic to lignocaine were excluded. If the placebo group felt pain, it was documented and were given adequate analgesia of diclofenac sodium. Patients in the lignocaine group received appropriate management in case of pain or adverse reaction to lignocaine. Intraoperative pain as reported by the participant and documented by an external observer was measured using the universal visual analogue scale and facial grimace scale. Chi-square (fischer exact) was used for cell counts less than 5. Results: There was statistically significant reduction of severe pain with 1% lignocaine paracervical block both intra-operatively and post-operatively with a p<0.0011when compared to normal saline as placebo. No complications were reported with the use of 1 % lignocaine as a paracervical block.