Local Anesthesia and Minimal Sedation

Level A: Recommendations are based primarily on good and consistent scientific evidence.
1 Preoperative NSAIDs reduce postoperative pain.
2. A 20-mL buffered 1% lidocaine PCB reduces procedure pain.
3. Oral or sublingual lorazepam does not decrease procedural pain but does reduce anxiety.
4. Oral opioids do not reduce procedural pain.
5. Cervical ripening should not be employed solely for pain reduction.
6. Waiting 3 min to allow onset of action for infiltration of anesthesia to the cervix does not improve pain scores.

Level B: Recommendations are based primarily on limited or inconsistent scientific evidence.
1. Verbal support techniques (support person, distraction) and music help women cope with the procedure but do not necessarily reduce pain.
2. Intracervical and paracervical blocks have similar effects
3. Vacuum source (electric vs. manual) does not affect pain scores.
4. Nitrous oxide in a 50/50 mixture does not appear to reduce pain.
5. Atraumatic tenacula are not associated with less pain than single-tooth tenacula.

Level C: Recommendations are based primarily on consensus and expert opinion.
1. A combination of treatments — including NSAIDs, local anesthesia and such nonpharmacologic interventions as verbal support — should be used to reduce pain and improve patient satisfaction during surgical abortion.