Setting: Miscarriages are a frequent complication of first trimester pregnancies and often require evacuation to prevent retention of products of conception. Evacuation of the uterus in incomplete miscarriage is associated with different levels of pain, thus, pain relief is necessary for evacuation. Pain reliefs can be non pharmacological or pharmacological (local anaesthesia, sedation, and general anaesthesia). Due to the systemic effects of some of the agents used as pain relief during evacuation and the paucity of health staff and equipments to monitor, there is need to compare the analgesic efficacy and side effect profile of paracervical block and conscious sedation in the surgical management of first trimester incomplete miscarriage. Objective: This study was designed to compare the analgesic efficacy and safety of paracervical block and conscious sedation in the surgical evacuation of the uterus among women presenting to the gynaecology emergency of Alex-Ekwueme Federal University Teaching Hospital Abakaliki with first trimester incomplete miscarriages. Methods: This was an open label, randomised control trial comparing pain relief by paracervical block and conscious sedation during manual vacuum aspiration of first trimester incomplete miscarriages in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State. The first arm received paracervical block of 4ml of lidocaine each at the 4 o’clock and 8 o’ clock positions and 2ml on the anterior lip of the cervix where the sponge holding forceps was used to grab the cervix, the second arm received intravenous conscious sedation comprising 30mg pentazocine and 10mg diazepam. Continuous variables were presented as mean and standard deviation (Mean ± 2SD) and analyzed with student t test, while categorical variables were analyzed using chi square. Mann xii Whitney test was done where applicable. A P value of ≤0.05 was taken to be statistically significant.