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Analgesia/Pain Management in First Trimester Surgical Abortion

MECKSTROTH, KAREN R. MD, MPH; MISHRA, KAVITA MD

Clinical Obstetrics & Gynecology: June 2009 - Volume 52 - Issue 2 - pp 160-170
doi: 10.1097/GRF.0b013e3181a2b0e8
Pregnancy Termination

Management of pain during abortion is a critical aspect of patient care. Although it is not always possible to offer a range of pain control options in every setting, individualizing pain medications as much as possible for patients' preferences is likely to improve satisfaction with the abortion experience. Evidence suggests that higher volume (at least 200 mg lidocaine) and deeper injections are beneficial for cervical block. Adding intravenous sedation with a moderate dose of fentanyl and midazolam reduces the pain scores. Oral benzodiazepines may improve satisfaction and anxiety. Deep sedation and general anesthesia are important options for women with significant medical conditions or complicated procedures.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California

Funding Disclosures: Dr Meckstroth receives compensation from Danco Laboratories, LLC (mifepristone) for providing third-party telephone consults to clinicians who call for expert advice on mifepristone.

Correspondence: Karen R. Meckstroth, MD, MPH, Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco General Hospital, Ward 6D, 1001 Potrero Avenue, San Francisco, CA. E-mail: meckstrothk@obgyn.ucsf.edu

© 2009 Lippincott Williams & Wilkins, Inc.