Intramuscular ketorolac versus oral ibuprofen for pain relief in first-trimester
surgical abortion: a randomized clinical trial.
Author(s): Braaten KP(1), Hurwitz S(2), Fortin J(3), Goldberg AB(4).
Affiliation(s): Author information:
(1)Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and
Women's Hospital, Boston, MA 02115, USA; Planned Parenthood League of
Massachusetts, Boston, MA 02215, USA. Electronic address: kpbraaten@partners.org.
(2)Center for Clinical Investigation, Department of Medicine, Brigham and Women's
Hospital, Boston, MA 02115, USA.
(3)Planned Parenthood League of Massachusetts, Boston, MA 02215, USA.
(4)Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and
Women's Hospital, Boston, MA 02115, USA; Planned Parenthood League of
Massachusetts, Boston, MA 02215, USA.
Publication date & source: 2014, Contraception. , 89(2):116-21
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.
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