Purpose: To evaluate the intra-operative course (including pain scores) of transcervical
procedures under paracervical block, with or without vaginal misoprostol as a cervical ripening
agent. Study design: This is a randomized double-blind placebo-controlled study, conducted
during the period from the I st October 2002 till the end of August 2003. Patients were randomly
allocated, by means of computer-generated numbers, to receive either placebo or 200 flg of
misoprostol 24 and 12 hours before surgery. Setting Department of Obstetrics and Gynecology,
Assiut University Hospital, Assiut, Egypt. Subjects: One hundred forty five cases with any
indications for cervical dilatation up to 8-mm or more were considered eligible for the trial, 23
refused to be operated under paracervical block and 20 cases didn't completed the protocol. The
remaining 102 cases were randomly allocated either for misoprostol (51 cases) or placebo (51
cases). Outcome measures: The primary outcome measure was intraoperative pain scores as
measured by visual analog scale (V AS). The secondary outcome measure in this study was the
ease of cervical dilatation. To avoid SUbjective bias, the ease of cervical dilatation was converted
to an objectively measurable and statistically manageable variable by development of a simplified
7-points scale for scoring the ease of cervical dilatation. Also the needs for conversion to general
anesthesia and side effects were also reported. Results: Pain scores were significantly lower in
misoprostol group compared to placebo group during cervical dilatation (P= 0.027, CI -10.5: -
0.6). However the difference was less obvious during the definitive transcervical procedure. Also
cervical dilatation scores were significantly lower (1.7±1 vs. 4.9±0.9) in misoprostol group than
they were in the placebo group (CI -2.4: -1.7 P= · " .) Dilatation time as well as the number of
cases needed conversion to general anesthesia were significantly less in the study group, however
there were no differences in the complication rates .Conclusions: The use of vaginal misoprostol
as a cervical ripening agent was found to be associated with lower pain scores in cases undergone
transcervical procedures under paracervical block than was the use of placebo. Also it was found
to be associated with lower cervical dilatation scores (easier cervical dilatation), consequently,
fewer cases needed conversion to general anesthesia. Key words: misoprostol, cervical ripening,
paracervical block, pain scores.