Addition of Buprenorphine to Paracervical Block for Pain Control During Osmotic Dilator Insertion
Status:
Recruiting
Trial end date:
2021-06-01
Target enrollment:
Participant gender:
Summary
Cervical preparation with osmotic dilators is commonly used prior to dilation and evacuation
(D&E) procedures to decrease the risk of complications. Women have described the pain of
osmotic dilator insertion as moderate to severe yet there have been few studies aimed at
addressing pain during and after osmotic dilator insertion. In addition to the discomfort
during insertion, pain after osmotic dilator insertion peaks at 2 hours post-insertion with
use of a lidocaine paracervical block. One randomized trial found that use of a paracervical
block with 1% buffered lidocaine decreased pain with osmotic dilator insertion compared to a
sham block. There are adjunct treatments to optimize analgesia with local anesthetics at a
variety of anatomic locations. Buprenorphine, a partial mu-opioid receptor agonist, has been
found to increase the quality of the anesthetic at the time of administration and increase
the duration of nerve block analgesia at several anatomic sites, though has never been
studied as an adjunct in a paracervical block. This has been used extensively in orthopedic
surgery with significant prolongation of the local anesthetic effect by almost threefold in
some studies.
Primary Aim: To compare the mean pain score at the time of osmotic dilator insertion among
women randomized to a 1% lidocaine and buprenorphine paracervical block compared to a 1%
lidocaine paracervical block alone.
Secondary Aim: To compare the mean pain score 2 hours after osmotic dilator insertion among
women randomized to a lidocaine and buprenorphine paracervical block compared to a lidocaine
paracervical block alone.
The investigators hypothesize that in patients undergoing osmotic dilator insertion in
preparation for dilation and evacuation, the addition of buprenorphine 0.15mg to a 1%
lidocaine paracervical block will be associated with lower mean pain scores at time of
osmotic dilator insertion compared to women who receive a 1% lidocaine paracervical block
alone.