Paracervical local anaesthesia for cervical dilatation and uterine interventions

Paracervical block involves injection of local anaesthetic around the cervix to numb nearby nerves. Cervical dilatation and uterine interventions (such as hysteroscopies, endometrial biopsies, fractional curettage, and suction terminations) can be performed without any analgesia or anaesthesia; with regional anaesthetic injections as with paracervical block; using oral or intravenous analgesics and sedatives; or under general anaesthesia. Many gynaecologists use paracervical block for uterine intervention but it is unclear how effective and safe this method is. We included 17 studies involving 1855 women undergoing uterine interventions who were randomly allocated to paracervical block or an alternative. We found that women had less pain during uterine intervention with paracervical block than with placebo injection (saline or water). However, in most studies this reduction was small. We did not find any evidence that paracervical block reduces residual pain after the procedure. Four studies that compared paracervical block with no treatment (not even a placebo injection) did not find any differences in level of pain experienced by women having hysteroscopies, evacuation of retained products of conception, and suction terminations. We found insufficient evidence to determine any differences in pain experienced by women having paracervical block compared to alternative regional anaesthetic methods, or the use of systemic analgesics and sedatives. Information on any important side effects was insufficient to determine if these are more common with paracervical block than with other methods of analgesia.