Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
This single center, double blind, randomized controlled trial will evaluate whether adding intravenous diphenhydramine to a standard moderate sedation regimen improves pain control during first trimester procedural abortion. Participants undergoing uterine aspiration at less than 13 weeks gestation will be randomized 1 to 1 to receive standard moderate sedation with midazolam and fentanyl plus either diphenhydramine 50 mg intravenously or matching placebo. The primary outcome is participant reported pain during uterine aspiration measured by a 100 mm Visual Analog Scale.
Surgical abortion is commonly associated with pain and anxiety despite use of local anesthesia and moderate sedation. This study will evaluate the efficacy of intravenous diphenhydramine as an adjunct to a standard moderate sedation regimen for participants undergoing first trimester procedural abortion.
This is a single center, double blind, randomized, placebo controlled trial conducted at the University of Rochester Family Planning Clinic and Strong Memorial Hospital. Participants undergoing first trimester uterine aspiration at less than or equal to 13 weeks gestation will be randomized in a 1 to 1 ratio using a computer generated block randomization scheme to receive either intravenous diphenhydramine 50 mg or matching placebo, in addition to standard moderate sedation with midazolam and fentanyl. Participants, clinical staff, and outcome assessors will remain blinded to treatment assignment.
Pain will be assessed using a 100 mm Visual Analog Scale at baseline, during speculum placement, paracervical block, cervical dilation, uterine aspiration, 10 minutes after the procedure, and 1 hour after the procedure. Sedation depth during uterine aspiration will be assessed using the Modified Observer's Assessment of Alertness Sedation scale. Additional outcomes include total sedative medication dose, time to readiness for discharge, and sedation related adverse events.
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Diphenhydramine plus standard moderate sedation | Experimental | Participants receive intravenous diphenhydramine 50 mg prior to the procedure, in addition to standard moderate sedation with midazolam and fentanyl. Additional doses of midazolam and fentanyl may be administered during the procedure as clinically indicated. |
|
| Placebo plus standard moderate sedation | Placebo Comparator | Participants receive a matching intravenous placebo (normal saline) prior to the procedure, in addition to standard moderate sedation with midazolam and fentanyl. Additional doses of midazolam and fentanyl may be administered during the procedure as clinically indicated. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Diphenhydramine | Drug | Diphenhydramine 50 mg administered intravenously once prior to the procedure. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Participant-Reported Pain During Uterine Aspiration | Pain intensity will be measured using a 100 mm Visual Analog Scale (VAS). The VAS ranges from 0 to 100 mm, where 0 represents "no pain" and 100 represents "worst pain imaginable." Higher scores indicate greater pain intensity. This outcome measures the participant's perceived pain during uterine aspiration. | During the procedure, at the time of uterine aspiration |
| Measure | Description | Time Frame |
|---|---|---|
| Sedation Depth During Uterine Aspiration | Sedation depth will be assessed using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale. The MOAA/S scale ranges from 0 to 5, where 5 indicates fully alert and 0 indicates no response to painful stimulus. Lower scores indicate deeper levels of sedation. This outcome measures the level of sedation achieved during uterine aspiration. | During the procedure, at the time of uterine aspiration |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sarah Cavegila, MPH | Contact | 585-273-5734 | Sarah_Caveglia@URMC.Rochester.edu |
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D010146 | Pain |
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001523 | Mental Disorders |
Not provided
Not provided
| ID | Term |
|---|---|
| D004155 | Diphenhydramine |
| ID | Term |
|---|---|
| D005021 | Ethylamines |
| D000588 | Amines |
| D009930 | Organic Chemicals |
| D001559 | Benzhydryl Compounds |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Placebo | Drug | Matching placebo composed of normal saline administered intravenously once prior to the procedure. |
|
| Participant-Reported Pain at Speculum Placement | Pain intensity will be measured using a 100 mm Visual Analog Scale (VAS), where 0 represents "no pain" and 100 represents "worst pain imaginable." Higher scores indicate greater pain intensity. This outcome measures pain experienced during speculum placement. | During the procedure, at the time of speculum placement |
| Participant-Reported Pain at Paracervical Block | Pain intensity will be measured using a 100 mm Visual Analog Scale (VAS), where 0 represents "no pain" and 100 represents "worst pain imaginable." Higher scores indicate greater pain intensity. This outcome measures pain experienced during administration of the paracervical block. | During the procedure, at the time of Paracervical Block |
| Participant-Reported Pain at Cervical Dilation | Pain intensity will be measured using a 100 mm Visual Analog Scale (VAS), where 0 represents "no pain" and 100 represents "worst pain imaginable." Higher scores indicate greater pain intensity. This outcome measures pain experienced during cervical dilation. | During the procedure, at the time of Cervical Dilation |
| Participant-Reported Pain 10 Minutes After Procedure Completion | Pain intensity will be measured using a 100 mm Visual Analog Scale (VAS), where 0 represents "no pain" and 100 represents "worst pain imaginable." Higher scores indicate greater pain intensity. This outcome measures post-procedure pain at 10 minutes. | 10 minutes after completion of the procedure |
| Participant-Reported Pain 1 Hour After Procedure Completion | Pain intensity will be measured using a 100 mm Visual Analog Scale (VAS), where 0 represents "no pain" and 100 represents "worst pain imaginable." Higher scores indicate greater pain intensity. This outcome measures post-procedure pain at 1 hour. | 1 hour after completion of the procedure |
| Time to Readiness for Discharge | Time from procedure completion to when the participant meets discharge criteria, measured in minutes. Higher values indicate longer recovery time. | From completion of the procedure until discharge readiness, up to approximately 2 hours |
| Incidence of Sedation-Related Adverse Events | Number and proportion of participants experiencing sedation-related adverse events, including hypoxia, hypotension, use of reversal agents (naloxone or flumazenil), paradoxical agitation, respiratory depression requiring supplemental oxygen beyond nasal cannula, hypotension requiring vasopressors, or unplanned hospital admission. Higher values indicate greater incidence of adverse events. | From administration of study medication through discharge on the day of procedure |
| D001555 |
| Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |