Individual research recommendation details

Recommendation ID

NG140/5

Question

What local anaesthetic techniques are most effective for women having surgical abortion?

Any explanatory notes
(if applicable)

Why the committee made the recommendations

There was only limited evidence comparing different types of sedation or anaesthesia for surgical abortion. The evidence that was available did not show that any particular method was more effective. The committee are aware that women have different preferences on anaesthesia. For example:

• some women need to minimise their recovery time (if they are driving home, or if they care for dependents)

• some women are anxious about the procedure and would prefer not to be conscious during it.

With this in mind, the committee recommended discussing all the anaesthesia options and explaining the differences to the woman.

There was not enough evidence to recommend a specific method for administering local anaesthesia. The committee agreed that further research on local anaesthesia methods (including intrauterine anaesthesia) would be beneficial, so made a research recommendation.

There was good evidence that women who had intravenous conscious sedation experienced less pain and nausea than women who had oral conscious sedation. Women who had intravenous sedation were also more likely to say they would choose it again.

Inhalational anaesthetics cause dose-dependent uterine relaxation. This may cause more bleeding compared with other medications used for general anaesthesia, such as propofol. The evidence comparing propofol and sevoflurane did not show any difference in haemorrhage requiring transfusion or blood loss greater than 500 ml. However, this is a rare event and the evidence was from a single study, so the committee recommended more research.

How the recommendations might affect practice

These recommendations will increase awareness of the options available for sedation or anaesthesia for surgical abortion, reduce variations in practice, and increase the choice available to women.

The recommendations will also reduce the use of oral conscious sedation, which is currently used but is not as effective as intravenous conscious sedation. Intravenous conscious sedation takes effect quicker than oral conscious sedation and has a shorter recovery time, so resource use should be reduced and scheduling flexibility may be improved as women spend less time in hospital. The recommendations may lead to a rise in the number of women opting for intravenous conscious sedation, causing an increased need for staff trained in administering it. Although conscious sedation is not currently used in all abortion services in the NHS, its use is widespread in other areas (such as endoscopy and assisted conception). As there are staff experienced in administering conscious sedation for other procedures, the resource impact in terms of staff training is not likely to be large.

Full details of the evidence and the committee's discussion are in evidence review M: cervical priming before surgical abortion.

Source guidance details

Comes from guidance

Abortion care

Number

NG140

Date issued

September 2019

Other details