Paul Blumenthal


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    Wondering how to manage second trimester medical abortion or dilation & evacuation in the setting of an abnormally implanted placenta?

    Looking for advice on advancing the gestational age at which you and your team provide? Have questions about cervical preparation, offering a choice of method, managing prolonged inductions, or anything else related to medical or surgical methods of abortion after the first trimester? Bring your questions along to this panel of five leading experts in second trimester abortion care. Experienced, new and curious providers are all welcome to contribute to what should be a lively and wide-ranging discussion.

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    Self-Administered lidocaine gel for pain control with first trimester surgical abortion: a randomised trial (SALSA)

    Jennifer Conti, Klaira Lerma, Kate Shaw, Paul Blumenthal
    Stanford University School of Medicine Department of Obstetrics and Gynecology Division of Family Planning Services and Research, Palo Alto, California, USA

    Objective: To assess pain control during first trimester surgical abortion using a locally applied, patient-administered lidocaine gel compared to traditional lidocaine paracervical block.
    Methods: We conducted a randomised controlled trial of women undergoing surgical abortion at less than 12 weeks gestation in an outpatient clinic setting. Participants were randomised to receive 12ml of a 1% lidocaine paracervical block (PCB) or 20ml of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. In addition, all patients received sedation as per institutional standard. A 100mm visual analogue scale (VAS) was administered to measure anticipated pain, baseline pain, pain with speculum and tenaculum placement, pain with cervical dilatation (primary outcome), pain after suction aspiration and pain 30-45 minutes post-operatively.
    Results: 142 women were enrolled: 68 in the PCB group, 69 in the gel group. Two and three subjects were not analysed due to protocol deviations or drop-out, respectively. Socio-demographic characteristics and VAS scores at all time points, except for tenaculum placement, were similar between groups. Mean and median pain scores for the primary outcome (pain score immediately following cervical dilatation) did not differ between groups. This was also true when nulliparous and parous subjects were analysed separately. The median pain score with cervical dilatation was 65mm in the PCB group and 68mm in the gel group (p=.45). Likewise, there was no statistically significant difference between mean pain scores at any of the other time points measured (speculum placement (p=0.39), tenaculum placement (p=0.07), cervical dilatation (p=0.31), speculum removal (p=0.19) and post-procedure (p=.75).
    Conclusion: There were no statistically significant differences concerning pain control between self-administered lidocaine gel and a traditional paracervical lidocaine block. Lidocaine gel should be considered as an alternative, non-invasive approach to pain control for first trimester surgical abortion.