• Jennifer L Mankowski, Jessica Kingston, Thomas Moran, Charles W Nager, and Emily S Lukacz.
• Department of Reproductive Medicine, University of California, San Diego Medical Center, San Diego, California, USA. jmankowski@ucsd.edu
• Obstet Gynecol. 2009 May 1;113(5):1052-7.

ObjectiveTo estimate the efficacy of paracervical compared with intracervical administration of local anesthesia during first-trimester suction curettage.MethodsA double-blind, randomized controlled trial comparing paracervical with intracervical lidocaine was performed in women undergoing elective first-trimester suction curettage with conscious sedation. Pain was assessed at baseline, with dilation, and with curettage using a 10-cm visual analog scale (VAS). Assuming a minimal clinically important difference in pain score of 1.6 cm and a mean pain score (+/-standard deviation [SD]) of 4.7 (+/-2.9) cm for paracervical block, 120 patients would provide 80% power with an alpha of .05.ResultsFor the 132 women randomly assigned, no significant differences in VAS scores (mean+/-SD) were observed between paracervical and intracervical blocks during dilation (2.6+/-2.3 compared with 2.8+/-2.2, P=.72) or curettage (3.9+/-2.9 compared with 3.3+/-2.5, P=.16).ConclusionFor women undergoing first-trimester suction curettage with conscious sedation, there was no clinically meaningful difference in pain relief between paracervical and intracervical lidocaine. Providers should feel confident that both techniques provide equally effective and acceptable analgesia.

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