Prophylactic Compared With Therapeutic Ibuprofen Analgesia in First-Trimester Medical Abortion: A Randomized Controlled Trial

Raymond, Elizabeth G. MD, MPH; Weaver, Mark A. PhD; Louie, Karmen S. MS, MPH; Dean, Gillian MD, MPH; Porsch, Lauren MPH; Lichtenberg, E. Steve MD, MPH; Ali, Rose PA-C, MS; Arnesen, Michelle MPAS, PA-C

doi: 10.1097/AOG.0b013e31829d5a33
Original Research

OBJECTIVE: To compare the effectiveness of two oral analgesic regimens in first-trimester medical abortion.

METHODS: We randomly assigned 250 participants undergoing first-trimester abortion with mifepristone and misoprostol at three clinics to two ibuprofen regimens: therapeutic (800 mg every 4–6 hours as needed for pain) or prophylactic (800 mg starting 1 hour before the misoprostol dose, then every 4–6 hours for 48 hours regardless of pain, then as needed). We asked each participant to record her maximum pain on a scale of 0–10 daily thereafter.

RESULTS: Of participants assigned to the prophylactic and therapeutic regimens, 111 of 123 (90%) and 117 of 127 (92%), respectively, provided follow-up data. More than 80% of the participants in each group complied with their assigned treatment. Participants in the prophylactic group used substantially more ibuprofen than those in the therapeutic group (median of nine and four tablets, respectively). The mean maximum pain score was 7.1 in the prophylactic group and 7.3 in the therapeutic group (standard deviations 2.5 and 2.2, respectively); the difference was not statistically significant (P=.87, adjusted for site). Duration of pain, verbal pain ratings reported at follow-up, and use of other analgesics did not differ significantly by group (all P>.05). No significant benefit of the prophylactic regimen was apparent in any population subgroup. Abortion failure and ibuprofen side effects in the two groups were similar.

CONCLUSION: We found no evidence that prophylactic administration of ibuprofen reduces pain severity or duration in first-trimester medical abortion. The average pain severity experienced by participants using both regimens was high.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01457521.

LEVEL OF EVIDENCE: I

Prophylactic administration of ibuprofen offers no identifiable benefit over ibuprofen as needed in minimizing pain in first-trimester medical abortion.

Gynuity Health Projects and Planned Parenthood of New York City, New York, New York; the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Northwestern University Feinberg School of Medicine and Family Planning Associates, Chicago, Illinois.

Corresponding author: Elizabeth G. Raymond, MD, MPH, Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY 10010; e-mail: eraymond@gynuity.org.

Funded by the Society of Family Planning and an anonymous donor.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.