Pain control in first-trimester surgical abortion: a systematic review of randomized controlled trials

Background

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

Study Design

Following the guidelines for a Cochrane review, we systematically searched for and reviewed 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.

Results

We included 40 trials with 5131 participants. Because of heterogeneity, we divided studies into seven groups:Local anesthesia: Data were insufficient to show a clear benefit of a paracervical block (PCB) compared to no PCB. Reported mean pain scores (10-point scale) during dilation and aspiration were improved with carbonated lidocaine [weighted mean difference (WMD), −0.80; 95% confidence interval (CI), −0.89 to −0.71; WMD, −0.96; 95% CI, −1.67 to −0.25], 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).PCB with premedication: Ibuprofen and naproxen resulted in small reduction of intra- and postoperative pain.Conscious sedation: The addition of conscious intravenous sedation using diazepam and fentanyl to PCB decreased procedural pain.General anesthesia: Conscious sedation increased intraoperative but decreased postoperative pain compared to general anesthesia (GA) [Peto odds ratio (Peto OR) 14.77 (95%, CI 4.91-44.38) and Peto OR 7.47 (95% CI, 2.2-25.36) 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 cyclooxygenase (COX)-2 inhibitor etoricoxib; the nonselective COX inhibitors lornoxicam, diclofenac and ketorolac IM; and the opioid nalbuphine improved postoperative pain.Nonpharmacological intervention: Listening to music decreased procedural pain.No major complication was observed.

Conclusions

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

Pain control in first-trimester and second-trimester medical termination of pregnancy: a systematic review

Background

Pain is a predictable feature of medical abortion in both the first trimester and the second trimester. We sought to evaluate optimal analgesia regimens during medical abortion.

Study Design

We searched the PubMed and Cochrane databases from inception to March 2010 for publications of trials comparing methods of pain control during first-trimester medical abortion (<12 completed weeks' gestation) and second-trimester medical abortion (13–24 completed weeks' gestation). Standard data abstraction templates were used to systematically assess and summarize data.

Results

Of 363 articles, 10 articles reporting the results of nine studies met inclusion criteria. Heterogeneity of analgesia regimens and medical abortion protocols prevented meta-analysis. Four studies conducted in women with pregnancies <8 completed weeks' gestation found that prophylactic acetaminophen, acetaminophen+codeine, ibuprofen or alverine did not reduce medical abortion pain; however, administration of ibuprofen after onset of cramping reduced pain and subsequent analgesia use. In second-trimester medical abortion, one study found that women treated with fentanyl (50 mcg) patient-controlled analgesia (PCA) had better satisfaction and pain relief than women treated with fentanyl (25 mcg) or morphine PCA, but found no difference in delivery/demand ratio; three studies found little effect of adjuvant treatment with metoclopramide or paracervical block on pain; one study found that women at >15 weeks' gestation who received diclofenac with the first misoprostol dose required less opioid analgesia than women who received acetaminophen+codeine.

Conclusion

Few studies examine pain management during medical abortion, and heterogeneity of existing data limits comparison. Further research is needed to determine the optimal analgesia regimens for first-trimester and second-trimester medical termination of pregnancy. To facilitate comparability of data, researchers should use contemporary medical abortion regimens, outcomes and study instruments to measure pain.     

规范化疼痛护理对肋骨骨折疼痛的效果

目的研究疼痛护理运用于肋骨骨折患者术后的疼痛护理效果。方法选取2017年12月-2018年12月份本院收治的肋骨骨折患者90例作为本次研究对象,90例患者均已进行手术,采用抽签方式随机分为对照组观察组两组,每组45例,对照组患者采用术后常规护理,观察组在常规护理的基础上采用规范化疼痛护理,对比两组患者的疼痛评分。结果观察组患者的疼痛评分明显低于对照组患者,差异有统计学意义(P <0.05)。结论针对肋骨骨折患者术后在此基础上,采用疼痛护理干预,对患者的疼痛可进行有效缓解,促进患者早日康复,提高了患者的生活质量。