Local Anesthesia and Minimal Sedation
Conclusions and recommendations
1 Preoperative NSAIDs reduce postoperative pain.
2. A 20-mL buffered 1% lidocaine PCB reduces procedure pain.
3. Oral or sublingual lorazepam does not decrease procedural pain but does reduce anxiety.
4. Oral opioids do not reduce procedural pain.
5. Cervical ripening should not be employed solely for pain reduction.
6. Waiting 3 min to allow onset of action for infiltration of anesthesia to the cervix does not improve pain scores.
Level B: Recommendations are based primarily on limited or inconsistent scientific evidence.
1. Verbal support techniques (support person, distraction) and music help women cope with the procedure but do not necessarily reduce pain.
2. Intracervical and paracervical blocks have similar effects
3. Vacuum source (electric vs. manual) does not affect pain scores.
4. Nitrous oxide in a 50/50 mixture does not appear to reduce pain.
5. Atraumatic tenacula are not associated with less pain than single-tooth tenacula.
Level C: Recommendations are based primarily on consensus and expert opinion.
1. A combination of treatments — including NSAIDs, local anesthesia and such nonpharmacologic interventions as verbal support — should be used to reduce pain and improve patient satisfaction during surgical abortion.
Recommendation Grading
Overview
Title
Local Anesthesia and Minimal Sedation
Authoring Organization
Society of Family Planning
Publication Month/Year
June 1, 2018
Last Updated Month/Year
January 22, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
This document will focus on nonpharmacologic modalities to reduce pain and pharmacologic interventions up to the level of minimal sedation
Target Patient Population
Patients undergo surgical abortion
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D000758 - Anesthesia, D000772 - Anesthesia, Local, D016292 - Conscious Sedation, D000894 - Anti-Inflammatory Agents, Non-Steroidal, D000032 - Abortion, Therapeutic, D000028 - Abortion, Induced, D000023 - Abortion Applicants, D037881 - Aborted Fetus
Keywords
anesthesia, Pain Management, abortion
Source Citation
VOLUME 97, ISSUE 6, P471-477, JUNE 01, 2018 DOI:https://doi.org/10.1016/j.contraception.2018.01.014