Paracervical block with combined ketorolac and lidocaine in first-trimester surgical abortion: a randomized controlled trial.
OBJECTIVE
To study the effects of a paracervical block with combined ketorolac and lidocaine on perceived pain during first-trimester surgical abortion.


METHODS
A double-masked, placebo-controlled, randomized clinical trial of 50 women undergoing first-trimester surgical abortions (before 11 weeks of gestation) received either oral ibuprofen with a lidocaine-alone paracervical block or an oral placebo and paracervical block with combined ketorolac and lidocaine. Women completed a series of 100-mm visual analog scales (anchors: 0=none, 100 mm=worst imaginable) to measure their perceived pain (anticipated pain, pain during and after surgical abortion, and total satisfaction).


RESULTS
Twenty-five women received preoperative oral ibuprofen followed by paracervical block with lidocaine alone, and 25 received oral placebo followed by paracervical block with combined ketorolac and lidocaine. Groups were similar with respect to sociodemographic variables. Women who received paracervical block with combined ketorolac and lidocaine reported significantly less pain after cervical dilation (59.8 compared with 74.8 mm, P<.05). The groups did not differ in perceived procedure-related or postoperative pain. There was no difference in overall satisfaction with pain control between the two groups (63.6 compared with 62.9 mm, P=.93).


CONCLUSIONS
Paracervical block with combined ketorolac and lidocaine significantly decreases perceived pain associated with cervical dilation during first-trimester surgical abortion. This analgesic mixture may be offered as an alternative pain regimen to women seeking first-trimester surgical abortion. It may also offer improved pain control in other gynecologic procedures necessitating cervical dilation.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00617097.


METHODS
I.
Cansino
Catherine
C
From Johns Hopkins Bayview Medical Center, Baltimore, Maryland; and Oregon Health and Science University, Portland, Oregon.
Edelman
Alison
A
Burke
Anne
A
Jamshidi
Roxanne
R
D000028:Abortion, Induced / Q000009:adverse effects; D000328:Adult; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage*; D020910:Ketorolac / Q000008:administration & dosage*; D008012:Lidocaine / Q000008:administration & dosage*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D055815:Young Adult
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D008012:Lidocaine; D007052:Ibuprofen; D020910:Ketorolac