Pre-ovarian block versus paracervical block for oocyte retrieval

The role of paracervical block in the pain relief during egg collection in in-vitro fertilization (IVF) is still not confirmed. In this prospective, double-blind and placebo-controlled study, 135 patients undergoing egg collection in their first IVF cycle were randomized to receive 10 ml of 1.5% lignocaine (group A) or normal saline (group B) in the paracervical block and no local injection (group C). No differences were seen among the groups in the demographic data, the ovarian response, the duration of egg collection, the number of follicles punctured, the pregnancy rates and the pain levels related to blood taking, scanning and insertion of an i.v. cannula. All patients experienced similar pain scores for vaginal puncture but patients in group A experienced significantly less abdominal pain during egg collection, compared with those in group B and group C (P = 0.009 and P = 0.001 respectively; Mann-Whitney U-test). When lignocaine was used, the abdominal pain scores were reduced by 38.9 and 51.4% compared with placebo and no local injection respectively. We recommend that paracervical block with lignocaine should be used in conjunction with i.v. sedation/analgesia during egg collection performed through the transvaginal route under ultrasound guidance (TUGOR) to reduce the pain of the procedure.

Background: Curettage is a gynecological diagnostic and therapeutic procedures. Curettage actions causing sensation of pain although the pain threshold is different for each person. Local anesthesia is an effective choice for various minor gynecological procedures. One of them is paracervical block. Paracervical block reduces pain by blocking nerve impulses across the uterovaginal plexus. Another method is the injection of local anesthetic trough intracervical who works as an anesthetic infiltrating agent, distending the tissue, causing mechanical disruption of nerve impulses. Theoritically, intracervical lidocaine injection will require a lower level of precision than the blockade of peripheral nerves directly, more reliable and reproducible. We measured patient’s pain during curettage using the Visual Analogue Scale (VAS). Method: RCT Location of study: Bantul District Hospital, Wonosari District Hospital, and Banjarnegara Distric Hospital. Result and Discussion: The study included 60 patients who got curettage within inclusion criteria. Every time patients came, we performed randomization and divided the patients into two groups, the control group (paracervical) and intervention group (intracervical), 30 subjects each. VAS was measured 5 minute after curettage was started. Characteristics of subjects in curettage frequency, curettage indication, parity and educational level for both groups are equal, did not differ statistically. The results of the mean pain scale (VAS). In the control group was 42,33±16,583 and 34,33±18,880 on the treatment group. Mean difference was 8 mm, with 95% CI -1.124 to 17.124 and p=0.408. The difference was not significant statistically. The intracervical group has mild pain scale (VAS<44 mm) in 27 of 30 patient, compared to 15 of 30 patients in paracervical group. It result in Relative Risk (RR) of 1,532. Conclusion: Intracervical lidocaine injection can be considered as an alternative local anesthetic on curettage. The average pain scale did not differ significantly with paracervical block. And both of it located in VAS < 44mm (mild pain). Intracervical lidocaine injection even have RR= 1,532 compared with paracervical block to produce mild pain scale (VAS < 44 mm). Keywords: curettage; paracervical;intracervical ;VAS

To compare the effectiveness of three different doses of lignocaine used in paracervical block (PCB) during transvaginal ultrasound-guided oocyte retrieval (TUGOR) METHODS: In this double-blind study, 153 patients undergoing TUGOR in their first in vitro fertilization cycle were randomized to receive 50, 100, and 150 mg of lignocaine in PCB. Pain levels were measured by a 100-mm linear visual analogue scale (0 = none to 100 = intolerable). No differences were seen in the demographic data, the ovarian responses, the duration of TUGOR, and the number of follicles punctured. Vaginal and abdominal pain levels during TUGOR and 4 h after TUGOR were not significantly different among the three groups The median vaginal and abdominal pain levels during the retrieval were 22.0-24.0 and 30.0-32.0 respectively. The use of 50 mg of lignocaine is recommended in PCB because of the lack of improvement in pain relief on higher doses and potential dose-related risks.

To compare the effects of 2 different anesthetic techniques used for oocyte retrieval. Comparison was made based on the number of retrieved and fertilized oocytes, metaphase 2 (M2, mature) oocytes, and transferred embryos, as well as fertilization, pregnancy, and live birth rates. Ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization is one of the most common minor surgical procedures. Despite this, it is stressful and painful for the patient; most patients request sedation and/or pain relief. Propofol, which is frequently used for general anesthesia in such procedures, has been suspected to damage oocytes. Materials and methods: Results from 70 patients without premedication were compared in this randomized prospective study. Patients were divided into 2 groups based on treatment. Those in Group G received intravenous general anesthesia with atropine (10 \mug kg^{-1}), remifentanil (1 \mug kg^{-1}), and propofol (2.5 mg kg^{-1}), while patients in Group P received a paracervical block with 100 mg of prilocaine (2%) and 0.75 mg kg^{-1} of intramuscular meperidine. Results: Our results revealed no statistically significant difference between the 2 groups in terms of the fertilization rate. The numbers of retrieved and mature oocytes and transferred embryos and the pregnancy rate were greater in the general anesthesia group, although only the number of transferred embryos showed a statistically significant difference (P = 0.045). Conclusion: According to our data, both anesthesia techniques can be used for oocyte retrieval since there were no differences in fertilization, pregnancy, or live birth rates between the 2 groups.

Refining paracervical block techniques for pain control in first trimester surgical abortion: a randomized controlled noninferiority trial

Gonadotropin-releasing hormone agonist to induce final oocyte maturation prevents the development of ovarian hyperstimulation syndrome in high-risk patients and leads to improved clinical outcomes compared with coasting

To compare the effectiveness of paracervical block with intramuscular Diclofenac for pain relief during manual vacuum aspiration (MVA) for early pregnancy losses. This was an open label randomized controlled trial. Participants were randomized into two therapeutic groups (A and B) using computer generated numbers. Group A received intramuscular Diclofenac 75 mg. Group B received paracervical block using 1% Lidocaine. Participants were asked to rate their pain level on a continuous 10 cm visual analogue scale (VAS) from 0 (no pain) to 10 (the worst pain ever) within 5 minutes of completing the procedure. Participants' level of satisfaction was assessed within 30 minutes of completing the MVA using Likert scale. Data was analysed using the Statistical Package for Social Sciences (SPSS), Version 20. Test of statistical significance was set at 95% confidence level (P < 0.05). The primary outcome was the level of pain felt by the patient during the procedure (10 cm VAS). Secondary outcomes included patient's satisfaction and adverse events. There was significant difference in the mean pain level between the intramuscular diclofenac group; 6.5±1.5 (moderate) and those that received paracervical block; 2.3±1.5 (mild), (p-value=0.005). Patients' satisfaction was also better in paracervical block group compared to intramuscular diclofenac group, (p-value=0.005). Both groups were comparable in terms of complications and drug side effects. Findings from the study suggest that the use of paracervical block compared to intramuscular Diclofenac for pain relief during MVA for incomplete miscarriage significantly reduced pain, improved patients' satisfaction and was comparably safe.

Effect of alfentanil dosage during oocyte retrieval on fertilization and embryo quality

Prospective randomized, double-blinded, placebo-controlled trial of preoperative etoricoxib for pain relief in uterine fractional curettage under paracervical block

Paracervical block (PCB) given during labour reduces the uterine activity necessary for cervical dilatation. The aim of the present investigation was to find out whether this effect of PCB changes the form of the amniotic pressure curve. A preliminary investigation showed that the ascending limb of the amniotic pressure curve, A, consists of three phases. The first phase shows an increasing slope and is called the acceleration phase of the ascending limb, Aa; the second phase is rectilinear, Ar. The third phase has a decreasing slope, and is named the deceleration phase, Ad. The descending limb of the amniotic pressure curve, D, was found to have corresponding phases. The initial part has a downward increasing slope and is called the acceleration phase of the descending limb, Da. Then follows a rectilinear phase, Dr and finally a phase with a decreasing slope, the deceleration phase, Dd. The duration of each phase, except Dd, was measured during an observation and a treatment period in 27 patients receiving PCB, and 25 control cases who were given N2O/O2, pethidine, or a combination of both analgesics. The patients were strictly selected and allocated at random to either group. Local analgesia in combination with adrenaline was given at cervical dilatation 3-6 cm; 20 minutes were allowed to elapse from the administration of analgesia until registration of the contraction of the treatment period, to assure an established analgetic effect. PBC shortens Aa and Ad, but prolongs Ar. A + Da + Dr and Ad + Da are shortened while Dr is prolonged after PCB (Table IV). On the presumption that PCB inactivates a part of the lower uterine segment, the changes of Aa, Ar and Ad + Da were predictable. To determine the significance of adrenaline, another series of 21 patients were given PCB, injecting 0.25 per cent bupivacaine without adrenaline added to the solution. The duration of the phases before and after the block was compared. PCB without adrenaline brought about the same changes as it did with adrenaline, but the changes were smaller, only those of Aa, Ar, Dr and Ad + Da being statistically significant. The pressure curves of six patients receiving epidural block were examined using the same method as in the PCB and control groups. The changes typical of PCB did not occur after epidural block. The discovery of the six phases of the amniotic pressure curve, their change after PCB and the results of other investigators make possible a suggestion of the basic physiological processes that influence amniotic pressure during coordinated labour contractions. It is held that the form of the amniotic pressure curve can be explained in terms of contraction, relaxation, and propagation of a contraction and a relaxation wave.

Acupuncture has pain-relief effects, but no data were available on the use of transcutaneous electric acupoint stimulation (TEAS) in pain relief during oocyte retrieval. This study was designed to examine the effect of TEAS for pain relief in women undergoing transvaginal ultrasound-guided oocyte aspiration. This single-blinded, multicenter, randomized controlled trial was performed in China between May 2013 and May 2015. The subjects were randomized to mock TEAS and TEAS. TEAS or mock TEAS was administered 30 min before oocyte retrieval until the end of the operation. The primary and secondary endpoints were the pain measured using the visual analog scale (VAS) within 1 min and 1 hour after oocyte retrieval, respectively. Serum β-endorphin levels were tested in the first 50 patients/group. 390 women were undergoing oocyte retrieval. Pain levels evaluated using VAS within 1 min (18.6 ± 1.3 vs. 24.4 ± 1.7, P < 0.01) and 1 h after oocyte aspiration (4.6 ± 0.7 vs. 6.8 ± 0.8, P < 0.05) were lower in the TEAS group than in the mock TEAS group. Nausea assessment revealed a significantly lower VAS score in the TEAS group within 1 min (1.2 ± 0.4 vs. 2.9 ± 0.7, P < 0.033). Serum β-endorphin levels were significantly higher in the TEAS group than in the mock TEAS group (11.4 ± 0.5 vs. 9.1 ± 0.4, P < 0.001) after retrieval. Serum β-endorphin levels were higher in the TEAS group after the procedure than baseline (11.4 ± 0.5 vs. 9.1 ± 0.3, P < 0.001). Oocyte retrieval causes pain and discomfort, but TEAS is effective and safe for suppressing the pain and alleviating nausea associated with the operation.

ObjectiveIt has been suggested that intravaginal deposition of seminal plasma after ovum pick up for in vitro fertilization, IVF, increases pregnancy and live birth rates. Thus, the present study aimed to detect whether intravaginal exposure to prepared seminal plasma led to an absolute increase in live birth rate after IVF by 10 % compared to placebo. DesignDouble-blind, placebo-controlled prospective study. Outcome assessment was made before the type of intervention was unblinded. The outcome data were analyzed according to an intention-to-treat protocol. SubjectsCouples scheduled for an IVF treatment cycle, in total 792 couples (393 in the seminal plasma group and 399 in the control group) were recruited over a five-year period of inclusion in a single-center setting. InterventionOn the day of ovum pick up the couples were randomized to groups receiving either vaginal deposition of prepared seminal plasma from the partner or to saline. Both participants and physician were blind to the grouping. Main Outcome MeasuresThe primary outcome was live birth. The secondary outcomes were a positive pregnancy test, defined as human chorionic gonadotropin identified in urine three weeks after ovum pick up, and clinical pregnancy, defined as an intrauterine viable pregnancy assessed by transvaginal sonography after five to seven weeks. ResultsIn the index group, 35.4 % had a positive pregnancy test (RR 0.93, 95% CI 0.78-1.10), 28.8 % had a clinical pregnancy (RR 1.00, 95% CI 0.97-1.03) and 26.5 % had a live birth (RR 0.86, 95% CI 0.70-1.07), adjusted for day of transfer, female age and number of fertilized oocytes. Corresponding rates in the control group were 37.3 %, 33.6 % and 29.8 %. No statistically significant differences regarding outcomes between the two intervention groups were found. ConclusionPrepared seminal plasma applied in the vagina directly after ovum pick-up did not increase the rates of live birth or clinical pregnancies. The importance of immunological factors to allow the implantation of an embryo is not questioned, but no improvement in the live birth rates in IVF treatment by introducing the male partner´s prepared seminal plasma after ovum pick-up could be found.

Medical abortion beyond 12 weeks' gestation increases experienced pain. The effectiveness of pain management protocols remains to be evaluated. This was a secondary analysis of a randomised controlled trial, conducted in six Swedish hospitals from 2019 to 2022, investigating home administration of the first misoprostol dose. Paracetamol 1000 mg and a non-steroidal anti-inflammatory drug (NSAID) were provided with the first misoprostol dose and subsequent breakthrough pain medication as required. We recruited persons >18 years of age, with a viable singleton pregnancy between 12 weeks+1 day and 21 weeks+6 days of gestation. We collected data on patient-reported pain using a visual analogue scale (VAS, 0-100 mm) at fetal expulsion and maximum pain assessed retrospectively prior to discharge. We collected data on the use of breakthrough pain medication, satisfaction scores with pain relief, and VAS scores before/after administration of breakthrough analgesia. We included 425 individuals. The participants reported a mean VAS of 39.1 (SD 34.4) at expulsion and 65.4 (SD 28.6) as maximum pain (assessed after abortion before discharge) and 352/425 (82.8%) received breakthrough pain medication, with 266/425 (62.6%) receiving an oral opioid, 163/425 (38.4%) a paracervical block (PCB) and 86/425 (20.2%) a parenteral opioid. A total of 357/392 (91.1%) participants were satisfied with the pain relief. Administration of a PCB alone or following an opioid resulted in the largest decrease in VAS. Many participants reported high VAS scores but most of them were satisfied with their analgesic treatment. A PCB was associated with the highest effectiveness in alleviating pain.

Study question What is the outcome of intracytoplasmic sperm injection (ICSI) using testicular spermatozoa obtained on the day of oocyte pick-up (OPU) or the day before OPU. Summary answer Testicular spermatozoa were obtaining the one day before OPU does not affect fertilization rate, top quality embryo on day 3, and blastocyst utilization rate. What is known already Usually, TESE is performed just before OPU. OPU is generally cancelled if no sperm is retrieved. The use of fresh testicular spermatozoa, obtained the day before OPU could offer the couple and the caring team both medical and practical advantages. The benefits of this approach, however, has not been evaluated in detail. An uncontrolled preliminary study has revealed that regular fertilization and pregnancy rates could be achieved with sperm extraction performed one day before OPU. Study design, size, duration This was a single-center retrospective study in Bahceci BIH IVF center. Sixty-six patients suffering from azoospermia from January 2015 to December 2020 were evaluated. TESE was performed either on the OPU day (43 patients; group A) or one day before OPU (23 patients; group B). Participants/materials, setting, methods In this study, primary outcomes were motile spermatozoa at ICSI, fertilization, top quality embryo on day 3, and blastocyst utilization rate. Statistical analyses were performed with chi-squared tests. Main results and the role of chance There is no statistical difference fertilization rate (72.3% vs. 72.2, p &amp;gt; 0.05), top quality embryo rate on day 3 (58.3% vs 58.3%, p &amp;gt; 0.05) and blast utilization rate (43.98% vs 49.58%, p &amp;gt; 0.05) between group A and B, respectively. Limitations, reasons for caution The retrospective nature of this study may not eliminate potential bias. On the contrary, the strength of our study is that all procedures were performed by the same operators, so there are no operator-dependent differences. More research is needed to prove our findings. Wider implications of the findings: TESE procedure can be performed one day before OPU without compromising success. Trial registration number 1

Role of paracervical block in reducing postoperative pain after laparoscopic hysterectomy: A systematic reivew and meta-analysis of randomized controlled trials.