Table 5.
Paracervical and pre-ovarian block
| Author | Study population and design | Outcome |
|---|---|---|
| Wikland et al., 1990[40] | Comparative study of 46 women who received PCB with lidocaine 50 mg and 46 women who did not | The mean follicular fluid concentration of lidocaine was 0.36±1.1 μg/mL. The fertilisation rate did not vary in oocytes retrieved from follicles containing lidocaine in their fluid. The fertilisation, cleavage and pregnancy rates were similar in both groups |
| Corson et al., 1994[41] | Prospective, randomized, double-blinded, placebo-controlled study involving 101 women who received IV sedation, randomly allocated to either receive PCB or not | Patient and physician-assessed pain scores were lesser in the group that received the PCB along with the IV sedation |
| Christiaens et al., 1998[42] | Prospective study comparing GA with propofol and PCB in 202 women | The fertilisation, cleavage, implantation and ongoing pregnancy rates were similar in both groups |
| Ng et al., 1999[43] | Prospective, double-blinded, placebo-controlled study on 135 women, randomly allocated to receive 10 ml of 1.5% lignocaine (group A) or normal saline (group B) in the PCB and no local injection (group C) | The procedure duration, number of follicles punctured and pregnancy rates were similar in all groups. Though vaginal puncture pain score was similar in all groups, abdomen pain was significantly lesser by 40%–50% in group A when compared to the other groups |
| Ng et al., 2000[44] | Prospective, double-blinded study on 150 women, randomised to receive either 200 mg or 150 mg lignocaine in the PCB | The fertilisation, implantation and pregnancy rates were similar in both groups. The median pain levels during vaginal punctures and abdominal pain were similar in both groups. Therefore, 150 mg of lignocaine seemed to be satisfactory for the procedure |
| Ng et al., 2001[45] | Prospective double-blinded study of 150 women, randomised to receive either PCB alone or PCB with conscious sedation | Level of vaginal and abdominal pain was 2.5 times higher in women who received only PCB |
| Ramzy et al., 2001[46] | Prospective, randomised study to evaluate post-operative pain relief by administration of sub-ovarian capsule and vaginal puncture site local anaesthetic. Seventy-two women underwent TVOR under IV sedation, randomised to receive lignocaine (Group A, n=24), normal saline (Group B, n=24), or no intervention (Group C, n=24) after TVOR | Post-operative analgesic requirement was similar in all groups, (Group A-41.7%, Group B-41.7%, in Group C-29.2%). Subcapsular local anaesthetic administration did not prove useful |
| Ng et al., 2003[47] | Prospective, double-blinded study on 153 women under IV sedation, randomised to receive three different doses of either 50, 100 and 150 mg lignocaine in the PCB | Vaginal and abdominal pain levels during and 4 h after the procedure were not significantly different among the three groups. Therefore, authors recommend the use of 50 mg of lignocaine for PCB |
| Tummon et al., 2004[48] | Randomised trial comparing use of use of lidocaine gel or PCB with lidocaine in adjunct to IV sedation | Pain experience was more in the group on lidocaine vaginal gel when compared with lidocaine PCB |
| Öztürk et al., 2006[49] | Prospective comparative study of two groups (n=100) receiving either TIVA with remifentanil infusion alone or in combination with PCB | Haemodynamic and respiratory parameters were similar in both groups. Pain score, remifentanil requirement and post-operative nausea and vomiting was significantly higher in the group that received remifentanil alone (P<0.05) |
| Atashkhoii 2006[50] | Prospective randomised double-blinded study. Sixty-women were randomised to receive either CSA alone (Fentanyl + Midazolam + Propofol) or CSA with PCB | Vaginal and abdominal pain were significantly lesser in the CSA + PCB group. Propofol requirement was also significantly lesser in the PCB group (8.67±2.42 mg) when compared to CSA alone (25.60±5.29 mg), P<0.0005. Incidence of intraoperative and post-operative adverse effects were significantly lesser in the CSA + PCB group |
| Cerne et al., 2006[51] | Prospective, multicentre study, where 183 women were randomised to receive POB (n=96) or PCB (n=87) | The pain score, level of anxiety, alfentanil requirement, fertilisation rate, number of good-quality embryos and clinical pregnancy rates were similar in both groups |
| Gunaydin et al., 2007[52] | Randomised controlled trial involving 40 women, randomly allocated to receive either remifentanil infusion alone (n=20) or with PCB (n=20) | Plasma remifentanil concentration and pulmonary function was compared in both groups. Haemodynamic and respiratory parameters were similar in both groups. Remifentanil requirement and therefore plasma remifentanil concentration was significantly higher when adjuvant PCB was not given (P<0.05) |
| Milanini et al., 2008[53] | Retrospective study comparing local anaesthesia with continuous IV remifentanil | Number of oocytes retrieved were more and the procedure was more comfortable in the IV remifentanil group |
| Bumen et al., 2011[54] | Prospective randomised study comparing TIVA with remifentanil + propofol with PCB | Fertilisation rate was similar in both groups. Though the number of retrieved and mature oocytes, embryo numbers and pregnancy rate were higher in the TIVA group, only the increased number of embryos was statistically significant (P=0.045) |
| Oliveira et al., 2016[55] | Randomised double-blinded clinical trial involving 61 women who were randomly allocated to receive 1mcg/kg of fentanyl with 1.5 mg/kg of propofol (n=32), or 0.075mg/kg of midazolam with 0.25mcg/kg/min of remifentanil, and paracervical block with 3 mL of 2% lidocaine (n=29) | Haemodynamic and anaesthetic parameters were similar in both groups. Though pregnancy rate was higher in the fentanyl/propofol group (44% vs. 22%), it was not statistically significant |
| Rolland et al., 2017[56] | Non-randomised prospective cohort study, where 234 women received PCB and 247 women received GA | Post-operative vaginal and abdominal pain was significantly more in the PCB group when compared to the GA group (2.26±0.159 vs. 1.66±0.123, respectively, P=0.005, and 3.80±0.165 vs. 3.00±0.148, respectively, P<0.001). Therefore, patient satisfaction was also significantly more in the GA group, (P<0.001). Whereas, the live birth rates were similar in both groups (19.8% in the GA group vs. 20.9% in the PCB group, P=0.764) |
GA=GA=General anaesthesia, PCB=Paracervical, TIVA=Total intravenous anaesthesia, POB=Pre-ovarian block, CSA=Conscious sedation and analgesia, TVOR=Transvaginal oocyte retrieval