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4. Apply the paracervical block at time points 3, 5, 7 and 9 on the junction of the vaginal and cervical mucosa, under the cervical mucosa, not on the exocervix (Figure 3). • Insert the needle to a depth of 2.5 to 3.8 mm (do not exceed this depth as it involves risks of bladder injury or hollow viscus). • Aspirate to verify that you are not injecting into a blood vessel. • Administer 1 ml to rule out an allergic reaction. If not, complete the application slowly. • Slowly inject 2 to 5 ml of 1% lidocaine. • Wait 5 minutes, until the anesthetic takes effect. An example of a pain management plan includes the placement of a paracervical block, the administration of oral pain relievers 30

2.2.4 Evacuation procedure with vacuum aspiration The MVA technique is detailed below. Although most of the detailed concepts correspond to the two modalities of vacuum aspiration (electric or manual), emphasis is placed on the manual technique since it is currently available in most of the centers in the country. Depending on gestational age, vacuum aspiration abortion takes between 3 and 10 minutes and can be performed on an outpatient basis, using pain relievers and / or local anesthesia. 1. Prepare the instruments. Provide a sterile auxiliary table with 1 ring clamp, 1 speculum, 1 cervical clamp (Pozzi), 1 bowl with antiseptic, 1 fanny pack, 1 complete set of Hegar plugs, gauze pads, the MVA aspirator (see “Preparation and operation of the manual aspirator ”, page 49) and semi-rigid cannulas (open only the cannula to be used, according to the uterine height) (Figure 4). Before using the vacuum cleaner, make sure it maintains a vacuum; for

Protocol for the comprehensive care of people with the right to legal interruption of pregnancy 42

this, load the vacuum cleaner, wait a few minutes and then release the buttons to release the vacuum. The sound of air entering the aspirator is an indication that a vacuum has been created. If this does not happen, check that the aspirator is properly assembled, inspect the “O” ring for defects or foreign bodies and if it is well lubricated, and make sure that the cylinder is firmly seated in the valve. If the “O” ring is not well lubricated, xylocaine in jelly or water-based gel can be used as used for ultrasound (never use petroleum jelly or other petroleum derivatives).

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