Already from the beginning our group performed TVOR combined with conscious sedation. Our reason was driven by the belief that if TVOR could be accepted by the patients and performed under local anesthesia, it would bring down the cost of the whole IVF treatment.
Oocyte retrieval is supposed to be physically the most painful part of the IVF procedure, and various methods of analgesia have been tried over the years. Many groups therefore use general anesthesia. In our opinion, one of the leading advantages of transvaginal follicle puncture is then lost. A good analgesic method for oocyte retrieval has to give a satisfactory pain relief with rapid onset, rapid recovery, and ease of administration and monitoring. It is also important that it is safe and has no toxic effect on the oocytes.
Conscious sedation appears to be the most commonly used method of pain relief for oocyte retrieval in the United Kingdom and in the United States (24,25).
Randomized, controlled trials (RTC) suggest that pain relief is superior when a paracervical block (PCB) is used combined with sedation as compared to sedation alone (26,27). It has also been shown that patients who received only a PCB during egg collection experienced 2.5 times higher levels of vaginal and abdominal pain as compared to those who received both PCB and conscious sedation (28). With the PCB, the local anesthetic is usually deposited in four locations around the cervix in the vaginal mucosa. Accordingly, today we use in total 100 mg lidocaine (10 ml of 1% lidocaine, Xylocaine™ 10mg/ml, AstraZeneca Sverige AB, Sodertalje, Sweden) injected at four points around the cervix and alfentanil 0.5 mg IV. If needed, a supplementary 0.25 mg alfentanil (Rapifen 0.5mg/ml; Janssen-Cilag AB, Sollentuna, Sweden) is given once or twice during the procedure. With this combination, 99.5% of our oocyte aspirations are performed. The majority of our patients seem to have sufficient pain relief (29).
An interesting method for pain relief during oocyte aspiration is electro-acupuncture. The reason for exploring this method arose from an earlier study from our group where we tried to evaluate a possible positive effect of electro-acupuncture on ovarian blood flow (30). This study led us to also explore the possible positive effect on pain during oocyte aspiration (29). A recently published study comparing electro-acupuncture and conventional medical analgesia during oocyte aspiration showed, however, that no method seems to be superior to another (31). Hence, our experience is that electro-acupuncture can in many patients be a good alternative for pain relief during oocyte aspiration (32).
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