Nitrous oxide versus oral sedation for pain management of first-trimester surgical abortion - a randomized study

Objective: The objective of the study was to compare nitrous oxide with oxygen (N2O/O-2) to oral hydrocodone/acetaminophen and lorazepam for analgesia during first-trimester surgical abortion. Study design: This double-blind randomized trial assigned women undergoing first-trimester surgical abortion at < 11 weeks' gestation to inhaled N2O/O-2 vs. oral sedation for pain management. The N2O/O-2 group received up to 70:30 ratio during the procedure and placebo pills preprocedure; the oral group received inhaled oxygen during the procedure and oral hydrocodone/acetaminophen 5 mg/325 mg and lorazepam 1 mg preprocedure. The primary outcome was maximum procedural pain, assessed on a 100-mm visual analog scale (VAS; anchors 0=no pain and 100=worst pain) at 2 min postprocedure. A difference of 13 mm on the VAS was considered clinically significant. Satisfaction with pain management was measured on a 100-mm VAS (anchors 0=very unsatisfied, 100=very satisfied). Results: We randomized 140 women, 70 per study arm. Mean age of participants was 26 +/- 6.6 years; mean gestational age was 7.3 +/- 1.5 weeks. Mean maximum procedure pain scores were 52.5 +/- 26.7 and 60.8 +/- 24.4 for N2O/O-2 and oral groups, respectively (p=.09). Satisfaction with pain management was 69.3 +/- 28.4 and 61.5 +/- 30.4 for N2O/O-2 and oral groups. respectively (p=.15). Conclusion: We found no difference in mean procedural pain scores between women assigned to N2O/O-2 vs. those assigned to oral sedation for first-trimester surgical abortion. Satisfaction with both options was high. (c) 2017 Elsevier Inc. All rights reserved.