RCOG World Congress 2025

Cross-sectional Study Comparing Paracervical and Combined Paracervical-Fundal Block for Outpatient Novasure

Introduction:

NovaSure endometrial ablation is a widely used outpatient procedure for the management of heavy menstrual bleeding. While effective, pain during and after the procedure remains a significant barrier to patient comfort and procedural success. Local anaesthetictechniques such as the paracervical block are commonly used; however, their efficacy can be limited. This study explores whether supplementing the paracervical block with a fundal block improves pain control, enhances recovery, and reduces the rate of procedure abandonment

Results :

•Participants who received the combination block reported lower pain scores during the procedure (mean: 3) compared to those receiving paracervical block alone (mean: 6).

•Post-procedure, pain scores were mild to moderate, ranging from 1 to 5. At 24 hours, 40% of participants reported a pain score of 2, 32% a score of 1, and 12% no pain. Participants in the combination block group resumed normal activities within 1–2 days, compared to 2–3 days for the paracervical block group.

•The procedure was successful in 76% of participants.

•Complications occurred in 28% of cases, including vasovagal shock (16%), cervical/vaginal lacerations (8%), and two cases of suspected uterine perforation, all managed conservatively.

•Four participants experienced adverse reactions to local anaesthesia: two reported facial swelling, one experienced a vasovagal attack, and one reported dizziness. All reactions resolved promptly without intervention. The procedure was abandoned in four participants due pain intolerance three receiving the cervical block and 1 the combination block.

•Conclusion :

The combined paracervical + fundal block provides significantly better pain reliefthan paracervical block alone during NovaSure® ablation.

•Most participants reported minimal pain and resumed normal activities within 1–3 days.

•92% were satisfied, and 84% would recommend the procedure.

Only minor, self-limiting complications occurred, supporting the safety and effectiveness of this dual-block technique in the outpatient setting

Reference:

RCOG Good Practice Paper No. 16: Pain relief and informed decision-making for outpatient hysteroscopy and procedures. London: RCOG; 2022

RCOG World Congress 2025

Cross-sectional Study Comparing Paracervical and Combined Paracervical-Fundal Block for Outpatient Novasure

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