Prevention of Induced Abortion - Effect on Pain. Systematic Review of a Database

Abstract

Review of the current literature on pain prevention in induced abortion.An in - depth analysis of the guidelines of leading international and national organizations for prophylaxis of induced abortion-surgical and medicated abortion during the I-st and II-nd trimester in terms of pain response has been carried out. Shared with the author's many years of practical experience in order to assess the risks and benefits of the application of modern means of prophylaxis in artificial abortion and thus to improve the individual obstetric-gynecological practice. Methods: review of available literature from the last 10 years. Results and discussion:Paracetamol, oral lorazepam and nitric oxide do not improve pain control. Currently, the use of sedation is not recommended for Surgical abortion. Inhalation anaesthesia should not be used for sedation. Intravenous sedation with fentanyl and midazolam is recommended and safe - below 1.0% complications. In Medical abortion, 75.0% of women experience pain severe enough to require analgesia. The pain begins 2.5 to 4 hours after the use of perplex and lasts about an hour. During the extravehicular trimester, taking a higher number of doses intravenously is associated with more severe and frequent pain. In medicated abortion < 14 gw. non-steroidal anti-inflammatory drugs are recommended 30-45 minutes before the procedure. Non-steroidal medicines do not reduce the efficacy of urgencies. Routine administration of paracervical block before 13 gw. when using modern means for medicated abortion is unnecessary. Narcotic analgesics (Tramadol) do not affect pain in early Medical abortion and their routine use is not recommended. Conclusion:In Surgical abortion, analgesia is always offered. Most commonly, analgesics, such as non-steroidal anti-inflammatory drugs local anesthesia (paracervical block with Lidocaine 20.1%; or 10.2%),) and/ or sedation, supplemented with verbal sedation, are sufficient to relieve pain before mechanical cervical dilation and during uterine evacuation. The technique of deep paracervical injection of Lidocacaine at two points is recommended.