Pre-emptive effect of ibuprofen versus placebo on pain relief and success rates of medical abortion: a double-blind, randomized, controlled study

Capsule:
Pre-emptive use of ibuprofen had a statistically significant beneficial effect on the need for pain relief during a mifepristone and misoprostol regimen for medical abortion. Ibuprofen did not adversely affect the outcome of medical abortion.

Authors:
Sarit Avraham, B.M.Sc., Itai Gat, M.D., Nir-Ram Duvdevani, M.D., Jigal Haas, M.D., Yair Frenkel, M.D., Daniel S. Seidman, M.D.
Volume 97, Issue 3 , Pages 612-615, March 2012

Objective:
To determine the efficacy of pre-emptive administration of the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen vs. a placebo on pain relief during medical abortion and to evaluate whether NSAIDs interfere with the action of misoprostol.

Design:
Prospective, double-blind, randomized, controlled study.

Setting:
University-affiliated tertiary hospital.

Patient(s):
Sixty-one women who underwent first-trimester termination of pregnancy.

Intervention(s):
Patients received 600 mg mifepristone orally, followed by 400 μg oral misoprostol 2 days later. They were randomized to receive pre-emptively two tablets of 400 mg ibuprofen orally or a placebo, when taking the misoprostol. The patients completed a questionnaire about side effects and pain score and returned for an ultrasound follow-up examination 10–14 days after the medical abortion.

Main Outcome Measure(s):
Significant pain, assessed by the need for additional analgesia, and failure rates, defined by a need for surgical intervention.

Result(s):
Pre-emptive ibuprofen treatment was found to be more effective than a placebo in pain prevention, as determined by a significantly lower need for additional analgesia: 11 of 29 (38%) vs. 25 of 32 (78%), respectively. Treatment failure rate was not statistically different between the ibuprofen and placebo groups: 4 of 28 (14.2%) vs. 3 of 31 (9.7%), respectively. History of menstrual pain was predictive for the need of additional analgesia.

Conclusion(s):
Pre-emptive use of ibuprofen had a statistically significant beneficial effect on the need for pain relief during a mifepristone and misoprostol regimen for medical abortion. Ibuprofen did not adversely affect the outcome of medical abortion.

Clinical Trial Registration Number:
NCT00997074.

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