Intramuscular Ketorolac Versus Oral Ibuprofen for Pain Relief in First Trimester Suction Curettage

Intramuscular Ketorolac Versus Oral Ibuprofen for Pain Relief in First Trimester Suction Curettage: a Randomized Clinical Trial.

The aim of this study is to compare the effect of pre-procedural ketorolac to ibuprofen on immediate post-procedural pain scores in patients undergoing first trimester suction curettage with local anesthesia only.

Our primary hypothesis is that IM ketorolac compared to oral ibuprofen will result in an approximate 30% reduction in pain scores on a 21-point numerical rating scale immediately after the procedure.

Secondary hypotheses include:

• Pain scores on the 21-point scale will also be significantly lower in the ketorolac group immediately after cervical dilation and 15 minutes post-procedure.
• Fewer patients in the ketorolac group will rate their pain as "severe" on a subjective pain rating scale.
• Patients in the ketorolac group will be more satisfied with their pain control.
• Side effects will be similar between groups.

Inclusion Criteria:

• Women age 18 or older seeking suction curettage at Planned Parenthood League of Massachusetts (PPLM)
• Gestational age less than or equal to 11+6, confirmed by ultrasound
• Eligible for suction curettage according to PPLM protocols
• Choice of local anesthesia

Exclusion Criteria:

• Choice of IV sedation for pain control
• Hypersensitivity to NSAIDs or lidocaine
• Contraindications to NSAIDs:

Active renal disease Active hepatic disease Gastric ulcer disease or gastritis Long-term NSAID or aspirin use Bleeding disorder

• NSAIDs taken < 8 hours prior to procedure
• Need for cervical ripening with either misoprostol or mechanical priming agent (laminaria/Dilapan)
• Long-term narcotic use
• Unable or unwilling to complete required study procedures
• Previous participation in the study