Lidocaine and Dexamethasone for Paracervical Block Anesthesia in Women with Missed Abortion : Randomized Controlled Trial

Abstract

Aim of the work: nerve block is a technique whereby local anesthetic solutions are infiltrated around a nerve (or perineurally) to provide anesthesia and analgesia. Nerve block for intraoperative and postoperative pain management is associated with improved analgesia, fewer opioid-related adverse events, earlier ambulation and shorter hospital stay when compared to intravenous opioid analgesia alone.This study aimed to assess the efficacy of adding dexamethasone to lidocaine for cervical block anesthesia for prolonging the duration and anesthetic effect in women with missed abortion undergoing vacuum evacuation. Patients and methods: this study is a randomized controlled trial and it was conducted in accordance with the ethical committee protocols and informed consent procedures of Ain Shams University Maternity Hospital during the period between Augusts to December 2016.Sample size was calculated using PASS® version 11 programs, setting the type-1 error (α) at 0.05 and the power (1-β) at 0.8. Conclusion: para cervical block can be used as a safe and effective anesthetic technique in patients who need surgical uterine evacuation of missed abortion. Adding dexamethasone can increase effectiveness and duration of para cervical block. Intraoperative pain level was accepted in 80% of patients, these patients had no or mild to moderate accepted pain. We did not detect any postoperative complications in our patients including (excessive vaginal bleeding, hematoma or general manifestations of lidocaine toxicity) and It is recommended to apply PCB for cases of first trimester missed abortion who require uterine suction evacuation. Lidocaine is preferably mixed with dexamethasone to have better results as regards pain score. It is the anesthetic method of choice especially when general anesthesia is a high risk procedure.