title: Intramuscular ketorolac versus oral ibuprofen for pain relief in first-trimester surgical abortion: a randomized clinical trial.
abstract: OBJECTIVE
  Oral nonsteroidal antiinflammatory medications (NSAIDs) have been shown to reduce pain with first-trimester surgical abortion compared to placebo, but it is unclear if one NSAID is better than another. Some providers administer intramuscular ketorolac, though data regarding its efficacy in abortion are limited. This study was designed to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester surgical abortion.
  
  
  METHODS
  This was a randomized, double-blind, controlled trial. Women undergoing first-trimester surgical abortion with local anesthesia were randomized to preprocedural oral ibuprofen, 800 mg given 60-90 min preprocedure, or intramuscular ketorolac, 60 mg given 30-60 min preprocedure. The primary outcome was pain with uterine aspiration on a 21-point, 0-100, numerical rating scale. Secondary outcomes included pain with cervical dilation, postoperative pain and patient satisfaction.
  
  
  RESULTS
  Ninety-four women were enrolled; 47 were randomized to ibuprofen and 47 to ketorolac. The groups did not differ with regards to demographics, reproductive history or Depression Anxiety Stress Scale scores. Mean pain scores for suction curettage did not differ between groups (52.3 vs. 56.2, p=.53). There was also no difference in pain with cervical dilation (41.6 vs. 45.4, p=0.48) or postoperative pain (22.3 vs. 15.0 p=.076), though patients in the ketorolac group experienced significantly greater arm pain than those who received a placebo injection (30.4 vs. 15.6, p<.001). Satisfaction with pain control did not differ significantly by group.
  
  
  CONCLUSIONS
  Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen for first-trimester surgical abortion.
  
  
  CONCLUSIONS
  Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during first-trimester surgical abortion, is more expensive and causes patients significant arm discomfort. Its use should therefore be reserved for patients who cannot tolerate oral NSAIDs.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Planned Parenthood League of Massachusetts, Boston, MA 02215, USA. Electronic address: kpbraaten@partners.org.
authors.forename: Kari P
authors.initials: KP
authors.lastname: Braaten
authors.affiliation: Center for Clinical Investigation, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Hurwitz
authors.affiliation: Planned Parenthood League of Massachusetts, Boston, MA 02215, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fortin
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Planned Parenthood League of Massachusetts, Boston, MA 02215, USA.
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Goldberg
mesh_terms: D000028:Abortion, Induced; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000698:Analgesia / Q000379:methods*; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage*; D007273:Injections, Intramuscular; D020910:Ketorolac / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen; D020910:Ketorolac
keywords: Ibuprofen; Ketorolac; NSAIDs; Pain control; Surgical abortion