Ibuprofen and paracetamol for pain relief during medical abortion
D.S. Seidman, A. Livshitz, R. Machtinger, G. Yerushalmi, Y. Ben David, M. Spira, A. Moshe-Zahav, L. Lerner Geva, E. Schiff (Israel)
Department of Ob. & Gyn., Women and children's research unit and Gertner Institute for Epidemiology, Sheba Medical Center, both affiliated to Sackler School of Med., Tel-Aviv University, Tel-Aviv, Israel
Background. Non-steroidal anti-inflammatory drugs (NSAIDs) have long been avoided in pain relief protocols for medical abortion because of concern over their potential inhibition of prostaglandin induced uterine contractions.
Objective. To determine whether the use of the ibuprofen for pain relief is effective and whether it can adversely affect the outcome of medical termination.
Methods. In a prospective double-blind controlled study 120 women undergoing medical abortion with 600 mg oral mifepristone and 400 mcg oral misoprostol were randomized to receive ibuprofen or paracetamol when pain relief was necessary.
Results. Ibuprofen was found significantly more effective (p<0.0001) for pain relief after medical abortion compared with paracetamol. Other parameters that significantly influenced the pain score after administration of the analgesics included the pain score before the analgesia and abortion in the past. There was no difference in the failure rate of medical abortion, and the frequency of surgical intervention was slightly higher in the group that received paracetamol (16.3% versus 8.5%).
Conclusions. Ibuprofen was found highly efficient for pain reduction during medical abortion and more effective than paracetamol. We also found that a past history of a surgical or medical abortion was predictive for high pain scores. Importantly we found that despite its anti prostaglandin effects ibuprofen did not interfere with the action of misoprostol and was not associated with an increase in surgical interventions.