Abstract
Objective
Oral nonsteroidal antiinflammatory medications (NSAIDs) have been shown to reduce
pain with first-trimester surgical abortion compared to placebo, but it is unclear
if one NSAID is better than another. Some providers administer intramuscular ketorolac,
though data regarding its efficacy in abortion are limited. This study was designed
to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester
surgical abortion.
Study Design
This was a randomized, double-blind, controlled trial. Women undergoing first-trimester
surgical abortion with local anesthesia were randomized to preprocedural oral ibuprofen,
800 mg given 60–90 min preprocedure, or intramuscular ketorolac, 60 mg given 30–60
min preprocedure. The primary outcome was pain with uterine aspiration on a 21-point,
0–100, numerical rating scale. Secondary outcomes included pain with cervical dilation,
postoperative pain and patient satisfaction.
Results
Ninety-four women were enrolled; 47 were randomized to ibuprofen and 47 to ketorolac.
The groups did not differ with regards to demographics, reproductive history or Depression
Anxiety Stress Scale scores. Mean pain scores for suction curettage did not differ
between groups (52.3 vs. 56.2, p=.53). There was also no difference in pain with cervical
dilation (41.6 vs. 45.4, p=0.48) or postoperative pain (22.3 vs. 15.0 p=.076), though
patients in the ketorolac group experienced significantly greater arm pain than those
who received a placebo injection (30.4 vs. 15.6, p<.001). Satisfaction with pain control
did not differ significantly by group.
Conclusions
Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen
for first-trimester surgical abortion.
Implications
Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during
first-trimester surgical abortion, is more expensive and causes patients significant
arm discomfort. Its use should therefore be reserved for patients who cannot tolerate
oral NSAIDs.
Keywords
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Article info
Publication history
Published online: October 28, 2013
Accepted:
October 19,
2013
Received in revised form:
October 18,
2013
Received:
August 13,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
