Paracervical block with and without conscious sedation: a comparison of the pain levels during egg collection and the postoperative side effects

Objective: To compare the pain levels during egg collection and the subsequent postoperative side effects in patients receiving a paracervical block (PCB) with and without conscious sedation. Design: A prospective, randomized, double-blind, and placebo-controlled study. Setting: A tertiary assisted reproduction unit. Patient(s): 150 patients undergoing egg collection. Intervention(s): Randomized to receive PCB only (control group) and PCB in conjunction with conscious sedation (sedation group). Main Outcome Measure(s): Vaginal and abdominal pain levels; severity of postoperative side effects. Result(s): The median pain levels during vaginal punctures were 12.0 (2.5th-97.5th centiles: 0-84.3) and 30.0 (2.5th-97.5th centiles: 0-100) in the sedation and placebo groups, respectively. The corresponding median abdominal pain levels were 16.5 (2.5th-97.5th centiles: 0-100) and 43.0 (2.5th-97.5th centiles: 0-100). The pain levels were significantly higher in the placebo group than the sedation group. There were no significant differences between the two groups in the severity of nausea, vomiting, dizziness, and drowsiness. Conclusion(s): Patients who received only a PCB during the egg collection experienced 2.5 times higher levels of vaginal and abdominal pain as compared to those who received both PCB and conscious sedation. The use of PCB along is not recommended for all patients but it may be considered with selected patients after they have been given extensive counseling. Copyright © 2001 American Society for Reproductive Medicine.link_to_subscribed_fulltex

Comparison of two different doses of lignocaine used in paracervical block during oocyte collection in an IVF programme

We have recently demonstrated the efficacy of paracervical block (PCB) used in conjunction with conscious sedation during egg collection. The dosage of lignocaine used in various studies ranges from 50 mg to 200 mg. There are, however, no studies evaluating the efficacy of different doses of local anaesthetic agents used in PCB. In this prospective, double-blind and placebo-controlled study, 150 women undergoing egg collection in their first IVF cycle were randomized to receive 200 mg and 150 mg lignocaine in PCB. No differences were seen in the demographic data, the ovarian responses, the duration of egg collection and the number of follicles punctured. The fertilization, implantation and pregnancy rates were similar when either 150 mg or 200 mg lignocaine was employed. The median pain levels during vaginal punctures were 14.0 (2.5th-97.5th centiles: 0-75.4) and 14.0 (2.5th-97.5th centiles: 0-86.5) in patients receiving 200 mg and 150 mg lignocaine respectively, whereas the corresponding median abdominal pain levels were 14.0 (2.5th-97.5th centiles: 0-85.6) and 14.0 (2.5th-97.5th centiles: 0-99.1). These pain levels during egg collection were not significantly different between the two groups. The use of 200 mg lignocaine in PCB is not justified, even in the absence of toxic effects.link_to_subscribed_fulltex

A prospective, randomized, double-blind and placebo-controlled study to assess the efficacy of paracervical block in the pain relief during egg collection in IVF

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.link_to_OA_fulltex

In vitro fertilization and embryo transfer during natural cycles

OBJECTIVE: To report the results of in vitro fertilization and embryo transfer (IVF/ET) performed during natural cycles. STUDY DESIGN: A prospective clinical study. RESULTS: Thirty-two cycles were started in 19 patients who had regular ovulatory cycles and tubal factors or unexplained infertility only as the cause of infertility. Egg collection was performed in 12 cycles, and four pregnancies resulted from ET in eight cycles. The pregnancy rates were 12.5% per cycle initiated, 33.3% per retrieval cycle and 50% per transfer. CONCLUSION: Natural cycle IVF/ET offers a low-cost alternative to patients with infertility.link_to_subscribed_fulltex