• Catherine Cansino, Alison Edelman, Anne Burke, and Roxanne Jamshidi.
• Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA. ccansino@yahoo.com
• Obstet Gynecol. 2009 Dec 1;114(6):1220-6.

ObjectiveTo study the effects of a paracervical block with combined ketorolac and lidocaine on perceived pain during first-trimester surgical abortion.MethodsA 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).ResultsTwenty-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).ConclusionParacervical 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.Clinical Trial RegistrationClinicalTrials.gov, www.clinicaltrials.gov, NCT00617097.Level Of EvidenceI.

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