Title: Control of pain for women undergoing termination of pregnancy. Abstract.

POPLINE Document Number: 270910

Author(s):

Stubblefield PG

Source citation:

[Unpublished] 1988 Oct. Paper presented at The Christopher Tietze International Symposium on Women's Health in the Third World: The Impact of Unwanted Pregnancy, Rio de Janeiro, Brazil, 29-30 October, 1988. 4 p.

Abstract:

The choice of method for pain relief can maximize the safety of an abortion. Since general anesthesia increases the risk of death, it should be avoided. Reduction of anxiety which includes counsellors who greet and explore abortion related issues with the patient should be used. Patients should be taught relaxation techniques to be used during the abortion. All of this combined with reducing stressful stimuli will reduce the pain of the procedure. Prolonged suctioning and curetting should be avoided. Paracervical blocks are more effective at higher doses, and if a 5 minute waiting period is provided after administration. Epinephrine should not be used with the block. Narcotic analgesics (e.g. meperidine and fentanyl) given as small intravenous doses with the proper equipment in the presence of a trained staff will reduce pain. Augmented tranquilizers like diazepam should be avoided due to respiratory risks. If barbituate anesthesia is used, hospital equipment and procedure need to be used. Ketamine will be safer to use, but it needs to be administered in low doses with premedication of atropine and diazepam to stop hallucinations. Nitrous Oxide can be used to produce analgesia but it requires its own equipment to supply this gas as well as oxygen. Highest priority to reduce pain should be given to measures that reduce stress by providing psychological support of the patient. Next is to choose an abortion technique that is least painful which can entail the use of larger bore vacuum cannula for procedures at 8 weeks and beyond. For standard vacuum curettage, the next priority is for the physician to gain facility with proper application of the paracervical block, and then to wait several minutes before beginning the procedure.

Keywords:

Abortion
Health Services Administration
Stress
Counseling
Pain
Anesthesia
Treatment
Recommendations
Fertility Control, Postconception
Family Planning
Management
Organization and Administration
Psychological Factors
Behavior
Clinic Activities
Program Activities
Programs
Signs and Symptoms
Diseases