Intervention Review

Pain control in first trimester surgical abortion

  1. Regina-Maria Renner*,
  2. Jeffrey T.J. Jensen,
  3. Mark D.N. Nichols,
  4. Alison Edelman

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 15 APR 2009

Assessed as up-to-date: 24 DEC 2007

DOI: 10.1002/14651858.CD006712.pub2


How to Cite

Renner RM, Jensen JT, Nichols MD, Edelman A. Pain control in first trimester surgical abortion. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006712. DOI: 10.1002/14651858.CD006712.pub2.

Author Information

  1. Oregon Health and Science University, Dept. of Obstetrics and Gynaecology, Portland, Oregon, USA

*Regina-Maria Renner, Dept. of Obstetrics and Gynaecology, Oregon Health and Science University, 3181 SW Sam Jackson Street, Portland, Oregon, OR 97239, USA. rennerr@ohsu.edu.

Publication History

  1. Publication Status: New
  2. Published Online: 15 APR 2009

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

First trimester abortions especially cervical dilation and suction aspiration are associated with pain, despite various methods of pain control.

Objectives

Compare different methods of pain control during first trimester surgical abortion.

Search methods

We searched multiple electronic databases with the appropriate key words, as well as reference lists of articles, and contacted professionals to seek other trials.

Selection criteria

Randomized controlled trials comparing methods of pain control in first trimester surgical abortion at less than 14 weeks gestational age using electric or manual suction aspiration. Outcomes included intra- and postoperative pain, side effects, recovery measures and satisfaction.

Data collection and analysis

Two reviewers independently extracted data. Meta-analysis results are expressed as weighted mean difference (WMD) or Peto Odds ratio with 95% confidence interval (CI).

Main results

We included forty studies with 5131 participants. Due to heterogeneity we divided studies into 7 groups:

Local anesthesia: Data was insufficient to show a clear benefit of a paracervical block (PCB) compared to no PCB or a PCB with bacteriostatic saline. Pain scores during dilation and aspiration were improved with deep injection (WMD -1.64 95% CI -3.21 to -0.08; WMD 1.00 95% CI 1.09 to 0.91), and with adding a 4% intrauterine lidocaine infusion (WMD -2.0 95% CI -3.29 to -0.71, WMD -2.8 95% CI -3.95 to -1.65 with dilation and aspiration respectively).

PCB with premedication: Ibuprofen and naproxen resulted in small reduction of intra- and post-operative pain.

Analgesia: Diclofenac-sodium did not reduce pain.

Conscious sedation: The addition of conscious intravenous sedation using diazepam and fentanyl to PCB decreased procedural pain.

General anesthesia (GA): Conscious sedation increased intraoperative but decreased postoperative pain compared to GA (Peto OR 14.77 95% CI 4.91 to 44.38, and Peto OR 7.47 95% CI 2.2 to 25.36 for dilation and aspiration respectively, and WMD 1.00 95% CI 1.77 to 0.23 postoperatively). Inhalation anesthetics are associated with increased blood loss (p<0.001).

GA with premedication: The COX 2 inhibitor etoricoxib, the non-selective COX inhibitors lornoxicam, diclofenac and ketorolac IM, and the opioid nalbuphine were improved postoperative pain.

Non-pharmacological intervention: Listening to music decreased procedural pain.

No major complication was observed.

Authors' conclusions

Conscious sedation, GA and some non-pharmacological interventions decreased procedural and postoperative pain, while being safe and satisfactory to patients. Data on the widely used PCB is inadequate to support its use, and it needs to be further studied to determine any benefit.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Pain control in first trimester surgical abortion.

Multiple methods of pain control in first trimester surgical abortion at less than 14 weeks gestational age using electric or manual suction aspiration are available, and appear both safe and effective. Pain control methods can be divided in local anesthesia, conscious sedation, general anesthesia and non-pharmacological methods. Data to support the benefit of the widely used local aneathetic is inadequate. While general anesthesia achieved complete pain control during the procedure, other forms of anesthesia such as conscious sedation with a paracervical block improved postoperative pain control.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

第一孕期人工流產的疼痛控制

即使有多種止痛方式,第一孕期的流產,仍舊會引起疼痛,尤其像是子宮頸擴張或真空抽吸術。

目標

第一孕期人工流產不同止痛方式的比較

搜尋策略

我們以適當關鍵字在網路上搜尋多個電子資料庫,以及文章的參考文獻,並且聯絡作者去尋找其他臨床試驗。

選擇標準

在第一孕期小於14週使用電動或手動真空抽吸實施的人工流產,以隨機對照性的臨床試驗比較疼痛控制的方法。結果包括術中和術後的疼痛、副作用、恢復程度和病人的滿意度都列入結果統計。

資料收集與分析

兩位研究人員個別擷取資料,資料分析採用加權平均差異(weighted mean difference, WMD)或有95%信賴區間的Peto Odds ratio。

主要結論

我們搜集了包括5131個試驗者的40個研究。依據資料的異質性分成7組:局部麻醉:資料不足以顯示子宮頸旁麻醉比沒接受子宮頸旁麻醉或子宮頸旁麻醉加無菌生理食鹽水來得好。在子宮頸擴張或真空抽吸時,疼痛分數能因深部注射(WMD −1.64 95% CI −3.21 to −0.08; WMD 1.00 95% CI 1.09 to 0.91),或加子宮內灌注4%lidocaine(子宮擴張:WMD −2.0 95% CI −3.29 to −0.71, 真空抽吸WMD −2.8 95% CI −3.95 to −1.65)而有所改善。Ibuprofen和naproxen在子宮頸旁麻醉前使用也能減少小部分術中和術後的疼痛, Diclofenacsodium對疼痛並無幫助,而清醒時以diazepam和fentanyl經靜脈注射鎮定亦能減少子宮頸旁麻醉術中的疼痛。全身麻醉:和全身麻醉比起來,清醒時的鎮定會增加術中疼痛但是減少術後疼痛(子宮頸擴張Peto OR 14.77 95% CI 4.91 to 44.38, 和真空抽吸Peto OR 7.47 95% CI 2.2 to 25.36,WMD 1.00 95% CI 1.77 to 0.23)。吸入性麻醉可能會增加出血(p<0.001)。COX2抑制劑etoricoxib、非選擇性COX抑制劑lornoxicam和diclofenac、肌肉注射ketorolac、和鴉片類nalbuphine在全身性麻醉的前置藥物使用上都能改善術後的疼痛。非藥物式的方式像是聽音樂也可以減少手術的疼痛。在各種止痛方式使用上,並沒有發現有任何嚴重的併發症。

作者結論

清醒時的鎮定、全身麻醉和一些非藥物式的止痛方式,能安全減少術中和術後的疼痛並讓病人滿意, 但這些數據在目前廣泛使用的子宮頸旁麻醉並未表現,需要更多的研究去確定。

翻譯人

本摘要由臺灣大學附設醫院蔡可欣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

有為數不少的止痛方式,可安全且有效地應用在第一孕期小於14週經電動和手動的真空抽吸術人工流產止痛上;止痛方式可分成局部麻醉、清醒時的鎮定、全身麻醉或非藥物的方式。資料並未顯示目前廣泛使用的局部麻醉有好處,全身性麻醉可達到術中的完全止痛,其他形式的麻醉像是清醒時的子宮頸旁麻醉鎮定,對術後的疼痛則有幫助。