Complex Family Planning, Obstetrics and Gynecology Department, Stanford University, Palo Alto, California, USA.
Curr Opin Obstet Gynecol. 2021 Dec 1;33(6):440-444. doi: 10.1097/GCO.0000000000000754.
To review the current literature focusing on pain management and experiences during abortion care.
Analgesic options in abortion care address pain associated with the procedure, osmotic dilator insertion, and cervical preparation. The paracervical block (PCB) is effective for pain control in first and second trimester abortions. Lower volume PCBs demonstrate non inferiority with osmotic dilator placement compared with higher volume PCBs with lower potential for toxicity. Self-administered vaginal lidocaine gel is noninferior to PCB in first trimester abortions. Preoperative oral narcotics and sedation do not reduce pain in first trimester abortions; however, the latter may reduce anxiety. For second trimester abortions, narcotics or gabapentin do not improve postoperative pain, yet up to half of patients will use narcotics if offered. Nonpharmacological methods have shown success in pain management. Music and doula support do not improve pain; however, patients would recommend these modalities, indicating some benefit that went unmeasured. Auricular acupuncture and transcutaneous electrical nerve stimulation (TENS) reduce pain and anxiety during first trimester abortions.
Several modalities reduce pain during abortion care; however, pain alone does not reflect patient satisfaction. Development of multidimensional measures for pain control assessment has the potential to capture the patient's overall experience.
综述目前关于流产护理中疼痛管理和体验的文献。
流产护理中的镇痛选择可解决与手术、渗透扩张器插入和宫颈准备相关的疼痛。子宫旁阻滞（PCB）对第一和第二孕期流产的疼痛控制有效。与高容量 PCB 相比，低容量 PCB 显示出非劣效性，毒性较低。自我给予的阴道利多卡因凝胶在第一孕期流产中与 PCB 非劣效。术前口服阿片类药物和镇静剂并不能减轻第一孕期流产中的疼痛；然而，后者可能减轻焦虑。对于第二孕期流产，阿片类药物或加巴喷丁不能改善术后疼痛，但如果提供，多达一半的患者会使用阿片类药物。非药物方法已成功用于疼痛管理。音乐和导乐支持并不能减轻疼痛；然而，患者会推荐这些方法，表明存在一些未测量的益处。耳针和经皮电神经刺激（TENS）可减轻第一孕期流产中的疼痛和焦虑。
几种方法可减轻流产护理中的疼痛；然而，疼痛本身并不能反映患者的满意度。开发多维疼痛控制评估措施有可能捕捉到患者的整体体验。
