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17 February 2010

Clinical Update: Vacuum aspiration under local anaesthetic

In her Q&A column for Abortion Review, BPAS’ Medical Director Patricia Lohr examines developments and discussions in abortion provision.

Q) What is vacuum aspiration under local anaesthetic?

Vacuum aspiration is a method of abortion where a cannula is inserted into the uterus and gentle suction is applied to remove the pregnancy. The suction is created by an electric vacuum machine or a hand-held syringe called a manual vacuum aspirator.

Pain is managed with a combination of oral analgesia (such as ibuprofen) and local anaesthetic (lidocaine) injected into or next to the cervix. Lidocaine gel can also be used in the cervical canal. The injection or gel reduces discomfort from the passage of instruments or dilators through the cervix while the analgesic is intended to calm the pain from uterine cramping during the evacuation.

Another important aspect of pain control during these procedures is good communication with the woman about what is happening and ‘vocal local’ - comforting or distracting conversation with the woman which is frequently done by an assistant and/or the surgeon.

Q) What advantages does this have over general anaesthetic?

Probably the greatest advantage of local over general anaesthetic is the length of the recovery period. The recovery period from a general anaesthetic is typically 2 hours but only about 30 minutes, or sometimes less, with a local anaesthetic.

In addition, women do not experience drowsiness or other after-effects of sedating medication given with a general anaesthetic. This may help women feel more in control during the procedure and be important for women who need to drive after the procedure, work, or care for children or other family members or who do not have an escort to look after them afterwards.

There is also no need to fast for a local anaesthetic. This can be very helpful for women with medical problems, such as diabetes. Finally, for some women, it may be safer to have a procedure under local rather than general anaesthesia, for example very obese women.

Q) What are the disadvantages?

Administration of analgesia and local anaesthetic reduces the pain associated with a vacuum aspiration but does not remove it completely. Experiencing any pain may be unacceptable to some women, as may remaining awake during the entire procedure.

Although a vacuum aspiration is short in duration (about 10 minutes from start to finish, with the aspiration lasting only a few minutes), women who have this procedure will need to remain calm and controlled throughout for the procedure to be performed safely. It is important that women understand what they will experience during a procedure under local anaesthetic and actively choose to have their abortion by this method.

Q) To what gestation can vacuum aspiration under local anaesthetic be performed?

At BPAS, we currently offer manual vacuum aspiration under local anaesthetic to 12 weeks’ gestation. Electric vacuum aspiration can be performed to about 14-15 weeks’ gestation. This isn’t to say that there is an absolute gestational age limit to which abortion procedures under local anaesthetic can be performed. It is even possible to perform dilatation and evacuation under local anaesthetic safely and satisfactorily at advanced gestational ages.

Q) What is the scope of BPAS’ provision of this method?

At present, most surgical abortions performed at BPAS are done under general anaesthetic but our provision of local anaesthetic procedures is increasing. I would like to see BPAS expand the gestational ages at which abortions are performed under local anaesthetic as it offers yet another option, along with medical abortion, general anaesthetic and conscious sedation, for a woman to have the abortion procedure she feels is right for her.

It may also allow us to care for some women with medical problems who cannot have a general anaesthetic in a freestanding clinic access their abortion with us. This is important because it can be difficult to locate an NHS provider for some women, particularly after about 16 weeks’ gestation.

This article appears in the Winter 2010 print edition of Abortion Review, which can be downloaded for free here.

Also read:

Abortion Review topic archive: Clinical Update Q&A