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Pain control in first trimester surgical abortion

  • Review
  • Intervention




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


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.












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。


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。


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。



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



Plain language summary

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.