SUMMARY POINTS

SKILL

 

  • Pain perception includes both physical and psychosocial elements, and is best managed with both non-pharmacological and pharmacological techniques.
  • Paracervical block helps reduce pain, and there are many variations on technique.
  • Oral medications such as NSAIDs, opioids or anxiolytics may be used individually or together during uterine aspiration.
  • Intravenous pain management may be chosen if monitoring and staffing are available; patients may require provision of respiratory support.
  • Deep sedation (a.k.a. general anesthesia) is used, but is not routinely recommended (Ipas 2016).

 

SAFETY

 

  • Universal pre-procedure antibiotic prophylaxis for uterine aspiration is well supported by the available evidence.
  • Attention to allergies, concurrent medications, conditions that compromise respiratory status, recommended dose limits, and antidotes will improve safety.
  • The supplies in your emergency cart should be reviewed, along with procedures and regular simulations for emergency management.

 

ROLE

 

  • In addition to pain medications, utilize gentle procedural technique, deep-breathing techniques, distraction through conversation, the support of a partner, friend, doula, or medical assistant, and the reassuring tone of your voice.