Insights: Pain Management with Uterine Aspiration

September 22, 2015

Even brief periods of intense pain may have long-term consequences for women, including difficulty with future gynecological exams, pelvic pain or psychological issues.^1-4 Studies observing pain with uterine aspiration find clinicians often underestimate patient pain.⁵ Careful attention to local anesthesia, individualization of care, and/or moderate-dose IV sedation can help to reduce pain. General anesthesia is not recommended for routine procedures due to cost and increased risk.

Pain is a complex interaction of (1) sensory signals, (2) emotional state and (3) the cognitive evaluation of the cause and significance of the stimuli. ^{3, 6} Uterine aspiration for undesired pregnancy or miscarriage affects all three levels in many ways and therefore a multimodal approach to comfort is especially useful.

Multimodal pain control includes:

Non-pharmacologic strategies – Evidenced-based non-pharmacologic strategies that improve comfort and pain control include: establishing relationship and rapport with a patient; patient participation in the choice of anesthesia; creating a relaxing atmosphere including ambient music; and counseling techniques such as positive suggestion and diversion of attention. Non-pharmacologic strategies are strongly recommended for all women.
Systemic medications – NSAIDs and IV moderate sedation reduce pain. NSAID medications help with uterine pain, especially post procedure. Women often have preferences regarding feeling more awake or more relaxed/less aware for uterine aspiration. If oral medications are used, they should be individualized to the preference and estimated tolerance of the patient.
Local medication – Local medication significantly improves pain and is critical for uterine aspiration when the patient is awake. Less than the equivalent of 20 mL of 1% lidocaine is generally inadequate. This method of pain control is strongly recommended for all women.