Intracervical Block During Laminaria Insertion

NCT ID: NCT06478316

Last Updated: 2024-06-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-07-31

Study Completion Date

2026-12-31

Brief Summary

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Whether intracervical block with lidocaine 1% is superior to sham procedure - intracervical injection of saline 0.9% - in terms of pain control.

Detailed Description

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* Research Design - Double-blind randomized study
* Study Population - Women who are candidates for late termination of pregnancy by dilation and evacuation and approach for the insertion of laminaria will be recruited for the study.
* The women will be divided into two groups

* Research Group - Women who will undergo preparation for the insertion of laminaria by anesthesia with lidocaine spray, followed by an intracervical injection of 1% lidocaine.
* Control Group - Women who will be anesthetized with lidocaine spray + intracervical injection of an inactive substance (0.9% saline).
* Randomization will be performed using dedicated computer software according to blocks of 2-6 women.
* All women will be offered to take 400 mg of ibuprofen about half an hour before the procedure.

* In the research group - a 10 ml syringe will be filled with 7 ml of lidocaine and 1 ml of bicarbonate (total 70 mg of lidocaine).
* In the control group - a 10 ml syringe will be filled with 8 ml of 0.9% NaCl saline.
* Primary anesthesia will be performed using 10% lidocaine spray in up to 5 sprays.
* Injection into the cervix will be performed at 3, 6, 9, 12 o'clock positions, after prior aspiration, with a 23-gauge needle, about 2 ml per point.
* Laminaria type to be inserted - "small" diameter 3 mm, length 6.5 cm (MedGyn: Lombard, IL, USA, and Norscan: Westlake Village, CA, USA).

* At weeks 18-20, 7-9 laminaria will be inserted.
* Over 20 weeks - over 10 laminaria will be inserted.
* Number of participants in the study - 70.

Conditions

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Late Abortion Dilation and Evacuation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Study

a 10 ml syringe will be filled with 7 ml of lidocaine and 1 ml of bicarbonate (total 70 mg of lidocaine).

Group Type EXPERIMENTAL

Intracervical block

Intervention Type PROCEDURE

local injection of lidocain to the cervix

Control

a 10 ml syringe will be filled with 8 ml of 0.9% NaCl saline

Group Type SHAM_COMPARATOR

Intracervical block

Intervention Type PROCEDURE

local injection of lidocain to the cervix

Interventions

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Intracervical block

local injection of lidocain to the cervix

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Voluntary termination of pregnancy approved by a committee or missed abortion
* 18.0 to 22.5 gestational week (The gestational age in the case of a missed abortion is determined by the BPD - Biparietal Diameter, which is the determining measure for the ability to perform D\&E.)
* Singleton pregnancy

Exclusion Criteria

* Multiple pregnancy
* Women undergoing the procedure urgently due to cervical insufficiency, inevitable abortion, premature rupture of membranes, or suspected chorioamnionitis
* Allergy to lidocaine
* Women who do not speak Hebrew or English
* Women who have a guardian for any reason
* Women with a history of cesarean section
* Women with abnormal placental implantation, such as placenta previa or suspected placenta accreta
* Women with a psychiatric illness
* Women with a history of alcoholism or drug abuse
* Women who required a "two-stage" laminaria insertion will not be included in the analysis. In cases where the cervix does not allow the insertion of the required number of laminaria, the process is carried out in two stages: in the first stage, the maximum possible number is inserted, the woman is hospitalized, and after a few hours when some initial dilation of the cervix has occurred, the laminaria are removed and new ones are inserted according to the required number
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Assaf-Harofeh Medical Center

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Matan Mor, MD

Role: PRINCIPAL_INVESTIGATOR

Assaf-Harofeh Medical Center

Central Contacts

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Matan Mor, MD

Role: CONTACT

00972506462862

References

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Fox MC, Hayes JL; Society of Family Planning. Cervical preparation for second-trimester surgical abortion prior to 20 weeks of gestation. Contraception. 2007 Dec;76(6):486-95. doi: 10.1016/j.contraception.2007.09.004. Epub 2007 Nov 9.

Reference Type RESULT
PMID: 18061709 (View on PubMed)

Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine perforation during curettage abortion. JAMA. 1984 Apr 27;251(16):2108-11.

Reference Type RESULT
PMID: 6708260 (View on PubMed)

Borgatta L, Roncari D, Sonalkar S, Mark A, Hou MY, Finneseth M, Vragovic O. Mifepristone vs. osmotic dilator insertion for cervical preparation prior to surgical abortion at 14-16 weeks: a randomized trial. Contraception. 2012 Nov;86(5):567-71. doi: 10.1016/j.contraception.2012.05.002. Epub 2012 Jun 6.

Reference Type RESULT
PMID: 22682721 (View on PubMed)

Prairie BA, Lauria MR, Kapp N, Mackenzie T, Baker ER, George KE. Mifepristone versus laminaria: a randomized controlled trial of cervical ripening in midtrimester termination. Contraception. 2007 Nov;76(5):383-8. doi: 10.1016/j.contraception.2007.07.008. Epub 2007 Oct 4.

Reference Type RESULT
PMID: 17963864 (View on PubMed)

Mercier RJ, Liberty A. Intrauterine lidocaine for pain control during laminaria insertion: a randomized controlled trial. Contraception. 2014 Dec;90(6):594-600. doi: 10.1016/j.contraception.2014.07.008. Epub 2014 Jul 23.

Reference Type RESULT
PMID: 25139724 (View on PubMed)

Shaw KA, Lerma K. Update on second-trimester surgical abortion. Curr Opin Obstet Gynecol. 2016 Dec;28(6):510-516. doi: 10.1097/GCO.0000000000000318.

Reference Type RESULT
PMID: 27684047 (View on PubMed)

Ramesh S, Roston A, Zimmerman L, Patel A, Lichtenberg ES, Chor J. Misoprostol 1 to 3 h preprocedure vs. overnight osmotic dilators prior to early second-trimester surgical abortion. Contraception. 2015 Sep;92(3):234-40. doi: 10.1016/j.contraception.2015.04.005. Epub 2015 Apr 16.

Reference Type RESULT
PMID: 25891258 (View on PubMed)

Lerma K, Blumenthal PD. Current and potential methods for second trimester abortion. Best Pract Res Clin Obstet Gynaecol. 2020 Feb;63:24-36. doi: 10.1016/j.bpobgyn.2019.05.006. Epub 2019 May 25.

Reference Type RESULT
PMID: 31281014 (View on PubMed)

Creinin MD, Schimmoeller NR, Matulich MC, Hou MY, Melo J, Chen MJ. Gabapentin for pain management after osmotic dilator insertion and prior to dilation and evacuation: A randomized controlled trial. Contraception. 2020 Mar;101(3):167-173. doi: 10.1016/j.contraception.2019.12.001. Epub 2020 Jan 10.

Reference Type RESULT
PMID: 31927028 (View on PubMed)

Other Identifiers

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ASF-0020-24

Identifier Type: -

Identifier Source: org_study_id

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