Abstract
Objectives
To compare pain levels and medication needs after placement of laminaria vs Dilapan-S,
and after dilation and evacuation (D&E).
Study Design
We conducted a single-blinded randomized control trial of patients undergoing D&E
at 15 0/7 to 23 6/7 weeks gestation, randomizing to cervical preparation with laminaria
or Dilapan-S. We compared pain levels and medication usage following dilator placement
(5 minutes; 2, 4, and 8 hours; the following morning) and D&E (1, 4, 24, and 48 hours).
Our primary outcome was median change from baseline pain, and secondary outcomes included
maximum pain timing and overall narcotic use. We compared baseline characteristics,
median pain increases and quantities of narcotics used.
Results
We analyzed 67 participants with laminaria (n = 34) and Dilapan-S (n = 33). More Dilapan-S
users had a prior vaginal delivery (n = 20, 60.6%) than laminaria users (n = 11, 32.4%),
p = 0.02. Maximum median pain was not statistically different (Laminaria: +3.5 (interquartile
range [IQR] +0.5, +6.5); Dilapan-S: +3 (IQR +1, +5); p = 0.42. Thirty-seven (63.8%) participants reported higher levels of pain following
dilator placement than D&E. Overall, 26 (42.6%) participants used narcotics during
their abortion episode, with no difference in median number of tablets between laminaria
(2, range 1–8) and Dilapan-S (4.5, range 1–15) participants (p = 0.34).
Conclusions
Median pain increase did not differ in participants receiving laminaria or Dilapan-S
for cervical preparation prior to D&E. The majority of patients will use a small amount
of narcotics if available.
Implications
The lack of difference in pain between laminaria and Dilapan-S enhances the applicability
of pain intervention research across dilator types. With over half of participants
using a small amount of narcotics during their D&E episode, pain management should
be individualized to patient needs.
Keywords
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Article info
Publication history
Published online: December 04, 2020
Accepted:
November 25,
2020
Received in revised form:
November 19,
2020
Received:
July 20,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
