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Paracervical Block Reduces Rate of Propofol Administration for Oocyte Retrieval
Abstract Number: F-25
Abstract Type: Original Research
Multiple methods of analgesia/sedation have been studied for oocyte retrieval in women undergoing subsequent in vitro fertilization. None has emerged as the unequivocal optimal technique, although a multimodal technique may be superior to those that rely on a single agent (opioid-only).1
To improve patient comfort and satisfaction, a paracervical block has been adapted as a new standard of care at our institution.
In this study, we examine the effects of a bupivacaine paracervical block on the propofol infusion rate required to perform oocyte retrievals.
After obtaining a waiver for IRB approval, we performed a retrospective analysis before and after the introduction of paracervical blocks. The block was performed with 10 ml of bupivacaine 0.5%, placed after insertion of the speculum, by two different proceduralists for oocyte retrieval in our IVF procedure suite.
All women eligible for the procedure in this outpatient suite need to be ASA 1 or 2, BMI less than 40 and without significant co-morbidities.
We reviewed the anesthesia records and assessed propofol consumption and duration of anesthesia in minutes.
Our main outcome measure was an average mg propofol per minute (mg Propofol/min) calculated from the total dose of propofol administered divided by the duration of the recorded anesthesia time in minutes.
Differences between the two unequal sized groups were compared using Welch's unequal variances t-test.
In the “no block” group, 31 consecutive women received midazolam, fentanyl, and propofol sedation. The “block” group consisted of 51 women patients undergoing the same procedure but with a paracervical block placed at the beginning of the surgery.
Women undergoing oocyte retrieval with the addition of a paracervical block received an average of 4.6 mg/min of propofol during the procedure, compared to 7.2 mg/min for those without a block (estimated difference 2.62 mg/ml, 95%CI 1.68 to 3.57, p < 0.001). Figure 1.
Our analysis suggests that a paracervical block placed before the oocyte retrieval reduces the rate of administered propofol required for the procedure. Further studies are warranted to evaluate effects on recovery room discharge times and oocyte survival.
1 Kwan et al (2013) Cochrane Database Syst Rev.