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Randomized Controlled Trial of Mefenamic Acid vs Paracervical Block for Relief of Pain for Outpatient Uterine Curettage


Pranom Buppasiri, MD*,
Saowanee Tangmanowutikul, MD*, Wilaiwan Yoosuk, BSc (Nursing)**

* Department of Obstetrics and Gynecology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University
** Nursing Division, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University


Objective: To compare the efficacy of mefenamic acid vs paracervical block for pain relief during and after fractional curettage.
Material and Method: Between January 1 and July 31, 2002, the authors enrolled 87 patients with abnormal uterine bleeding, who requested fractional curettage at the Outpatient Gynecologic Clinic, Srinagarind Hospital, Khon Kaen University. A simple randomization procedure was used to distribute the patients into a control group comprising 44 patients given a paracervical block and a treatment group comprising 43 patients given mefenamic acid (500 mg) 2 hours before starting the procedure.
Outcome measures: Pain was scored using a visual analogue scale (VAS range, 0 to 10).
Results: The median pain scores of the treatment types during endocervical, endometrial, immediately after, and 30 minutes after, fractional curettage were 2.5 vs 3.0 (p = 0.42), 6.5 vs 7.5 (p = 0.19), 4.0 vs 3.5 (p = 0.20) and 1.5 vs 1.0 (p = 0.17), respectively. The rate of complications was 6.8% (3 in 44) in the paracervical lignocaine injection group.
Conclusion: The efficacy of pain relief for fractional curettage using oral mefenamic acid (500 mg) two hours before the procedure was not statistically different from the paracervical block, but there were fewer side effects. Mefenamic acid should be considered an alternate pain relief during fractional curettage.

Keyword : Abnormal uterine bleeding, Fractional curettage, Paracervical block, Mefenamic acid

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