Abstract：
The incidence of first trimester pregnancy loss is around 10.0-20.0% of registered pregnancies. Manual vacuum aspiration is a safe, effective and acceptable option of treatment for patients diagnosed with first trimester pregnancy loss. Main disadvantage of MVA is the pain caused by manipulation of the cervix, the uterine suction and the cervical dilatation. This study showed the way how the pain and discomfort might be reduced. This was a cross-sectional comparative study was conducted at the obstetrics and Gynecological Department of Sadar hospital, Manikganj, Bangladesh from January 2017 to December 2017. All the consecutive women admitted and diagnosed as incomplete abortion, missed abortion and anembryonic pregnancy (blighted ovum) were included in this study. Sampling technique was purposive sampling. The objective of this study was to compare the effectiveness of paracervical block anesthesia with non-steroidal anti inflammatory drug (NSAID) for relief of pain during the manual vacuum aspiration procedure for the treatment of first trimester pregnancy loss. Total 120 cases were included in this study. Assigned study population were divided into two groups like Group A and Group B. 60 of the study population were included in Group A who were given paracervical block anesthesia 3 minutes before the procedure. Another 60 study population was included in Group B who was given diclofenac 75mg intramuscular injection, 30 minutes before the procedure. Both intraoperative and postoperative pain level was evaluated by using visual analog scale ranged from (0-10 points) 30 minutes after the procedure. At the same time the satisfaction level of the study population were measured by 5 points lickert scale. Regarding clinical profile of the study population it showed no significant difference in case of mean age, mean gestational age and mean duration of the procedure between two groups. The mean intraoperative pain score in Group A was 4.0±1.3, in Group B it was 5.4±1.5 (p=0.001) which was significant. So it showed that paracervical block anesthesia significantly reduced the pain in relation to diclofenac 75mg intramuscular injection. Mean postoperative pain level 30 minutes after procedure in Group A was 2.2±0.4 and in Group B was 2.4±0.4 (p=0.343), where post-operative pain is lower in Group A than Group B. Though this difference is not statistically significant (p=0.343). In Group A 73.0% (n=44) and in Group B 43.0% (n=26) study population were agreed that the procedure was easy. Most common adverse effect was epigastric pain which was 1.7% (n=1) in Group A and 10.0% (n=7) in Group B. Paracervical block significantly reduces intraoperative pain during Manual Vacuum Aspiration (MVA) procedure in the treatment of first trimester pregnancy loss in comparison to intramuscular injection of diclofenac. In conclusion it might be mentioned that regarding paracervical block anesthesia, efficacy is higher and side effects are less. Moreover paracervical block anesthesia is cost effective.
摘要：
妊娠早期流产的发生率约为登记妊娠的10.0-20.0％。手动真空抽吸是安全的，对于诊断为早三个月妊娠流产的患者，有效且可接受的治疗选择。MVA的主要缺点是子宫颈操作引起的疼痛，吸引子宫和宫颈扩张。这项研究显示了如何减轻疼痛和不适。这是一项在萨达医院妇产科进行的横断面比较研究,Manikganj,孟加拉国从2017年1月到2017年12月。所有连续入院并诊断为不完全流产的妇女，本研究包括流产和无胚胎妊娠(受精卵)。采样技术是有目的的采样。这项研究的目的是比较宫颈旁阻滞麻醉与非甾体抗炎药（NSAID）在手动真空抽吸过程中缓解疼痛的有效性，以治疗早孕期妊娠流产。本研究共纳入120例病例。将分配的研究人群分为两组，如A组和B组。在手术前3分钟给予宫颈旁阻滞麻醉的60名研究人群被纳入A组。另外60名研究人群纳入B组，给予双氯芬酸75mg肌肉注射，手术前30分钟。手术后30分钟使用视觉模拟量表（0-10分）评估术中和术后疼痛水平。同时用5分Lickert量表测量研究人群的满意度。关于研究人群的临床特征，在平均年龄的情况下没有显着差异，两组间的平均胎龄和平均手术时间.A组的平均术中疼痛评分为4.0±1.3，B组为5.4±1.5（p=0.001），差异有统计学意义。结果表明，宫颈旁阻滞麻醉明显减轻了双氯芬酸75mg肌肉注射的疼痛。术后30分钟平均疼痛水平A组为2.2±0.4，B组为2.4±0.4（p=0.343），其中A组的术后疼痛低于B组。尽管这种差异没有统计学意义（p=0.343）。在A组73.0%(n=44)和B组43.0%(n=26)的研究人群同意该程序是容易的。最常见的不良反应是上腹痛，A组为1.7％（n=1），B组为10.0％（n=7）。与肌内注射双氯芬酸相比，宫颈旁阻滞可显着减少手动真空抽吸（MVA）手术治疗早期妊娠流产期间的术中疼痛。总之，关于宫颈旁阻滞麻醉，疗效较高,副作用较少。此外，宫颈旁阻滞麻醉具有成本效益。
