Local Anesthesia and Minimal Sedation

Publication Date: June 1, 2018
Last Updated: March 14, 2022

Conclusions and recommendations

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.


Recommendation Grading




Local Anesthesia and Minimal Sedation

Authoring Organization

Publication Month/Year

June 1, 2018

Last Updated Month/Year

August 7, 2023

Document Type


External Publication Status


Country of Publication


Document Objectives

This document will focus on nonpharmacologic modalities to reduce pain and pharmacologic interventions up to the level of minimal sedation

Target Patient Population

Patients undergo surgical abortion

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Management, Treatment

Diseases/Conditions (MeSH)

D000758 - Anesthesia, D000772 - Anesthesia, Local, D016292 - Conscious Sedation, D000894 - Anti-Inflammatory Agents, Non-Steroidal, D000032 - Abortion, Therapeutic, D000028 - Abortion, Induced, D000023 - Abortion Applicants, D037881 - Aborted Fetus


anesthesia, Pain Management, abortion

Source Citation

 VOLUME 97, ISSUE 6, P471-477, JUNE 01, 2018 DOI:https://doi.org/10.1016/j.contraception.2018.01.014