Lidocaine and Pain Management in First Trimester Abortions

The Investigators intend to conduct a randomized, patient-blinded control trial at Oregon
Health and Science University and Planned Parenthood of the Columbia Willamette. Women will
be approached about this study after they have made a decision to terminate the pregnancy.
The women will be blinded and randomized into one of two study arms.

Group 1: the investigator will apply pressure with the capped needle of the paracervical
block at the cervical-vaginal reflexion at 4 and 8 o'clock. This will approximate the steps
involved in a paracervical block without injecting the patient. Following this, the patient
will receive a 5 milliliter intrauterine infusion of 4% lidocaine using a sterile 3mm Novak
curette. The infusion will be placed slowly over 3 minutes.

Group 2: a standard paracervical block (8 milliliter 1% lidocaine at 4 and 8 o'clock at the
cervical-vaginal reflection) will be placed. Following this, a 3 mm Novak curette will be
placed in the vagina and held to the external os of the cervix for 3 minutes. The curette
will not be placed through the cervix and no infusion will be performed. This will
approximate the steps involved in an intrauterine infusion without injecting the patient.

During the procedure, women in both groups will be asked to rate their pain at various times
using a 10 cm visual analog scale (VAS).

Inclusion Criteria:

- Good general health

- Age>18years

- English speaking

- Voluntarily requesting pregnancy termination

- Have an estimated gestation of up to 76 days since the first day of the preceding
menstrual period

- Confirmed by ultrasound

- Be able and willing to sign an informed consent

- Agree to the terms of the study

- All patients must be premedicated with Ibuprofen and Valium (per clinic protocols)

Exclusion Criteria:

- Significant physical or mental health condition

- A gestational age of 77 days or more

- Adnexal mass or tenderness on pelvic exam consistent with pelvic inflammatory disease

- Patients who require or request IV/intramuscular sedation

- Patients who refuse Ibuprofen, Valium and/or paracervical blocks

- Patients allergic to lidocaine

- Patients with known hepatic disease

- Patients weighing less than 100 lbs