Marie-Jeanne Martin

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    Pain treatment in local anaesthesia

     

    Marie Jeanne Martin  MD, Hopital d’Armentières – Armentières - France

                   

    I represent a team from an abortion centre, in the North of France. In this region, most abortions are practiced in public hospitals. We are a small team and I want to lay stress on the presence of counsellors fully fledged in the team.

    A modification in the law, in 2001, has authorized abortions until 14 weeks since last periods. This modification has generated a lot of discussions and debates, sometimes very severe between professionals, but not at all in the public opinion. During these discussions, some of our colleagues were very surprised to learn what we practiced all abortions with local anesthesia (whatever the term). They considered that general anesthesia was always indicated for pregnancy which were above 12 weeks since last periods because of pain.

     

    So, we asked ourselves on our « evaluation » of the pain felt and also on our method of local anesthesia. We asked us few questions:

    -   Are surgical abortions more painful after 12 weeks since last periods?

    -   What adequacy can be found between the level of pain felt by a woman and the evaluation of this pain by the practitioner of the aspiration ?

    -   It should be noted that during our current study, we have modified technique of anesthesia. Also we have introduced an additional question:

    -   Is this technique more effective on the level of pain felt ?

     

    The study deals with all the women having a chirurgical abortion whatever the term of the pregnancy. This study was made over a period of 4 months (from March 4 to July 11, 2003). This is an analysis of a subjective evaluation of the pain collected by means of the analogical visual scale, the scale being held vertically. The collection of these feelings was made during the hospitalization at 6 different periods. The presentation and the collection of the scale were made by the same nurse all along the study. Just after the aspiration, at the same time as his report, the doctor notes from 0 to 10 his own evaluation of the pain felt by the lady during the aspiration.

     

    We will present our work with the help of a short film. (see technical drawings in attached)

    Principles which are important are:

    -   Using medicines to dilate cervix, to calm down anxiety, to calm pain in advance.

    -   A warmth atmosphere, with attention, where we could be close.

    -   A technique, always looking for improving.

     

    We collected 188 exploitable cards (55 aspirations took place without addition of bicarbonate, that is to say approximately a third, 133 took place with bicarbonate which is to say two thirds of the total). Half of abortions were done between 9 and 11 weeks since last periods which is a representation of the French national statistics.

     

    It’s a modest study:

    -   by the number of “exploited” files since we have only 188 files

    -   and by the realization of the study itself and the results obtained since we are not accustomed a realization of studies.

     

    With the impression that the aspirations are felt by woman as more painful for the most advanced terms (superior with 12 weeks since last periods) we could answer : no

    and than on the contrary the aspirations of the smaller pregnancies hurt the most.

     

    With the search of the reliability of the evaluation of the pain, by the practitioner, one sees that whatever the doctor, there are errors in undercutting and on quotation, with tendency to on quotation. So this study gives us the opportunity of staying on our place and of committing us to remain vigilant not to plate our impressions like single truth..

     

    With the search for an improvement of the local anesthesia, it appears clearly that our new way of making (with addition of bicarbonate to the lidocaïne in order to plug acidity off it, and with multiple microinjections in the cervix) is much more effective and decreases pains to a significant degree.

     

    Our objectives are always to improve the accompanying of the women and the couples. The alleviation of this moment of their lives forms part of our objectives and this alleviation helps to reduce the painful. This is why we should seek the greater comfort for the lady (who is not the same think as greatest comfort for the doctor). And for this reason the presence in the team of full-time counselors, and this throughout the experience of the women and couples, is a paramount element in this alleviation of the procedure and thus in the pain felt.