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Pain Management for First-Trimester Uterine Aspiration

Moayedi, Ghazaleh DO*; Tschann, Mary PhD, MPH

Obstetrical & Gynecological Survey: March 2018 - Volume 73 - Issue 3 - p 174–181
doi: 10.1097/OGX.0000000000000544
CME ARTICLES
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CME

Importance First-trimester uterine aspiration can easily be performed in the office setting if adequate pain management for the patient is achieved. It is important for clinicians to understand evidence-based approaches for pain control to ensure a safe and efficient procedure.

Objective This article reviews the literature regarding pharmacologic and nonpharmacologic pain control options for first-trimester abortion performed in the clinical setting. Preoperative, procedural, and postoperative pain control are all reviewed.

Evidence Acquisition Authors searched the online database PubMed for relevant published literature through January 2018. To identify possible publications for review, the key word “abortion” was paired with the following key words: “pain,” “pain-control,” “pain management,” “aspiration,” “paracervical block,” “sedation, “non-pharmacologic,” and “post-operative.”

Results Optimizing pain control for first-trimester uterine aspiration may involve interventions before, during, and after the surgery. Evidence shows patients benefit from premedication with nonsteroidal anti-inflammatory drugs, a defined paracervical block technique, and an option to use one of several nonpharmacologic interventions.

Conclusions and Relevance Pain management for first-trimester uterine aspiration should be individualized for optimal patient satisfaction. Evidence supports multiple approaches to support this individualization. Targeted interventions before, during, and after the procedure should be offered to improve procedure experience and satisfaction.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completing this activity, the learner should be better able to identify at least 3 evidence-based pharmacologic pain interventions for first-trimester uterine aspiration, interpret evidence for nonpharmacologic pain management interventions for first-trimester uterine aspiration, analyze the gaps in knowledge for current pain management options, and compare predictors of pain for uterine aspiration.

*Clinical Instructor and †Researcher, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Ghazaleh Moayedi, DO, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawai'i, 1319 Punahou St, Ste 824, Honolulu, HI 96826. E-mail: gmoayedi@hawaii.edu.

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