What to do if you feel pain during early pregnancy abortion?

According to the World Health Organization (WHO), there are 42 million artificial abortions worldwide each year, of which nearly 90% are performed in the early stages of pregnancy (before the 14th week of pregnancy). Currently, the most commonly used abortion methods in clinical practice are vacuum aspiration and cervical dilation and curettage. If these two operations are performed in regular hospitals and by qualified medical personnel, artificial abortions in the early stages of pregnancy are very safe.

However, abortion, like other surgeries, can cause pain and discomfort to the patient. How to effectively control pain and anxiety during (and after) abortion has both physiological and psychological significance, and has always been valued by surgical providers.

Renner et al. retrieved clinical data on all surgical abortions with pain control before 14 weeks of gestation worldwide; among them, forty randomized controlled trials with relatively complete data and 5,131 subjects were included, and the effects of different pain control methods on pain control, patient satisfaction, side effects, and safety were compared.

Due to the large variety of pain control methods used in the included trials and the heterogeneity of the results, it is not possible to conduct a meta-analysis by combining the data; this evaluation is mainly based on appropriate group analysis. The results of the analysis of 40 trials showed:

① No major complications were reported in any of the trials.

②Ten studies (1,527 subjects) on local anesthesia with 1% lidocaine 20 ml paracervical block (PCB) showed that there was no significant difference in effect between PCB and no PCB or injection of normal saline; however, when PCB was deeply injected and when 4% lidocaine was added to the intrauterine injection, the pain scores of cervical dilation and negative pressure aspiration (measured by a visual analog scale) were improved; if the cervix was dilated 3 minutes after PCB, the pain could be relieved, but the pain caused by negative pressure aspiration was not reduced.

③ Three studies and 434 observations showed that oral administration of ibuprofen 600 mg or naproxen sodium 550 mg before PCB surgery could slightly reduce pain during and after surgery.

④ In a study (100 cases), there was no significant difference in clinical effect and acceptability between the analgesic diclofenac sodium 50 mg combined with the cervical ripening drug misoprostol 200 micrograms given 4 hours before surgery and the misoprostol alone.

⑤ Three small studies, with 274 observations, showed that when PCB was used, diazepam and fentanyl were given intravenously in a conscious state. Such conscious sedation can reduce surgical pain.

⑥14 studies involving 1,812 subjects underwent general anesthesia. The anesthetics used included halothane, enflurane, trichloroethylene, propofol, barbiturates (5-methohexital), thiopental sodium, ketamine, benzodiazepine minodad or etomidate. Compared with local anesthesia, general anesthesia was more effective in controlling pain during surgery, but it did not reduce postoperative pain. In addition, inhalation anesthesia increased blood loss during surgery (p<0.001).

⑦ The use of COX2 inhibitor etoricoxib, non-selective COX inhibitor lornoxicam, diclofenac and ketorolac intramuscular injection, and opioid nalbuphine before general anesthesia can improve postoperative pain.

⑧ Four smaller and more heterogeneous studies investigated the clinical effects of nonpharmacological interventions. Among patients undergoing PCB, hypnosis did not change the level of comfort during surgery but reduced the need for nitric oxide.

A study of 98 patients found that listening to stereo music reduced pain associated with vacuum aspiration compared with methoxyflurane. Other nonpharmacological interventions, such as providing sensory stimulation messages, pleasurable imagery, or analgesic imagery, did not alter pain during or after local anesthesia.

Based on the above results, Renner et al. came to the following two conclusions:

① Conscious sedation, general anesthesia and some non-drug interventions can reduce pain during and after early pregnancy abortion surgery, and are safe and satisfactory to the patients.

② Paracervical block anesthesia is widely used in clinical practice, but the existing evidence is insufficient to support its application, and further research is needed to determine whether it is indeed beneficial.