May 2012

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Background: The majority of patients undergoing first trimester surgical abortion in the United States receive oral ibuprofen and a paracervical block for pain control. Hydrocodone/acetaminophen (HC/APAP) is increasingly added to this regimen, and is recommended by the World Health Organization. The efficacy of oral opioid agonists for decreasing pain during surgical abortions has not been established. Objective: To study the effect of oral HC/APAP on patient pain perception during first trimester surgical abortion. Methods: A randomized, double-blinded, placebo-controlled trial of 120 women receiving two tablets of 5/325 mg HC/APAP or identical placebo administered prior to surgical abortion up to 10 6/7 weeks gestation. The primary outcome was pain with uterine aspiration reported on a 100 mm visual analogue scale. Secondary outcomes were pain at additional time points, satisfaction, side effects, adverse events, and need for additional medications. Linear regression analysis was performed to determine predictors of pain and satisfaction. Results: 121 subjects were enrolled. There were no differences in mean pain scores between patients receiving HC/APAP versus placebo at any procedural time point. There were no differences in satisfaction or need for additional pain medications. Subjects who received HC/APAP had more postoperative nausea than those receiving placebo, when controlling for baseline nausea. A trend towards greater postoperative sleepiness in the active drug group was observed. No medication-related adverse events were noted. In regression analysis, preoperative anxiety, expected pain, and race were significantly associated with procedural and postoperative pain. Pain during dilation and aspiration were the strongest predictors of patient satisfaction. Conclusion: Hydrocodone/acetaminophen does not decrease first trimester abortion pain among patients receiving ibuprofen, lorazepam, and a paracervical block. However, this medication may increase postoperative nausea and sleepiness.




School of Medicine



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