Paracervical Block versus General Anesthesia in Patients Undergoing Manual Vacuum Aspiration in the 1st Trimester Abortion

Abstract

Background & objective: Incomplete abortion remains a significant contributor to maternal morbidity, particularly in developing countries like Bangladesh. Manual Vacuum Aspiration (MVA) is an effective, lower-cost alternative to traditional surgical evacuation, yet the optimal anesthetic approach remains debated. This study aimed to assess the feasibility, safety, and clinical outcomes of MVA performed under paracervical block (PCB) compared to general anesthesia (GA). Methods: This comparative study was conducted at the Institute of Child & Mother Health (ICMH), Dhaka, involving 120 women (=12 weeks gestation) with incomplete abortions. Patients were randomized into two groups (n = 60 each): Group G received MVA under GA (propofol/fentanyl or thiopentone/halothane), and Group P received MVA under PCB (1% lidocaine). Pain was assessed using the Visual Analog Scale (VAS) at baseline and 30 minutes post-procedure. Clinical outcomes, including procedural duration and length of hospital stay, were recorded and analyzed. Results: Demographic characteristics were comparable between groups (p > 0.05). While both groups showed a progressive decline in VAS scores over time, the reduction was significantly more pronounced in Group P, with Group G maintaining higher overall pain intensity throughout the observation period. Notably, Group P demonstrated significantly shorter procedural durations (9.23 ± SD min vs. 12.5 ± SD min, p = 0.032) and significantly reduced hospital stays (5.4 ± SD hrs vs. 7.9 ± SD hrs, p = 0.012) compared to Group G. No major complications were reported in either cohort. Conclusion: Manual vacuum aspiration under paracervical block is a safe, efficient, and cost-effective alternative to general anesthesia for first-trimester abortion. Given the shorter recovery times and superior pain reduction post-procedure, PCB should be considered a preferred anesthetic method for MVA in resource-limited settings.

Ibrahim Card Med J 2025; 15 (2): 38-42