misoprostol and Pain--Postoperative

To identify the highest-ranked pharmacological and nonpharmacological interventions for pain relief during outpatient hysteroscopy.. We conducted an online bibliographic search in different databases from inception till July 2019. We included randomized controlled trials assessing effect of pharmacological and nonpharmacological interventions on pain relief during outpatient hysteroscopy. Our main outcomes were pain scores at different endpoints of the procedure. We applied this network meta-analysis based on the frequentist approach using statistical package 'netmeta' (version 1.0-1) in R.. The review included 39 randomized controlled trials (Women n = 3964). Misoprostol plus intracervical block anesthesia (mean difference [MD] = -3.32, 95% confidence interval [CI] [-6.06, -0.59]), misoprostol (MD = -1.92, 95% CI [-3.04, -0.81]) and IV analgesia (MD = -2.01, 95% CI [-3.27, -0.25]) were effective in reducing pain during the procedure compared to placebo. Ranking probability showed that misoprostol plus intracervical block anesthesia was the highest ranked pharmacological treatment for pain relief during the procedure (P score = 0.92) followed by misoprostol alone (P score = 0.78), and IV analgesia (P score = 0.76). Regarding nonpharmacological treatments, transcutaneous electrical nerve stimulation (TENS) showed a significant pain reduction compared to placebo (MD = -1.80, 95% CI [-3.31, -0.29]). TENS ranked as the best nonpharmacological treatment (P score = 0.80) followed by CO. Combination of misoprostol plus local anesthesia appears to be the most effective pharmacological approach for pain reduction during and after outpatient hysteroscopy. Nonpharmacological approaches as TENS and bladder distention showed considerable efficacy but should be further investigated.

Topics: Ambulatory Care; Anesthesia, Local; Female; Humans; Hysterotomy; Misoprostol; Network Meta-Analysis; Pain Management; Pain, Postoperative; Pain, Procedural; Randomized Controlled Trials as Topic

Medical and surgical methods can both be recommended for second trimester abortion (after 12-weeks of gestational age). Induced abortion with a mifepristone and misoprostol regimen is the preferred approach; where mifepristone is not available, misoprostol alone for medical abortion is also effective. Dilation and evacuation (D&E) is the procedure of choice for surgical abortions, and adequate cervical preparation contributes significantly to safety. Availability of drugs and instruments, ability to provide pain control, provider skill and comfort, client preference, cultural considerations, and local legislation all influence the method of abortion likely to be performed in a given setting. Both surgical and modern medical methods are safe and effective when provided by a trained, experienced provider.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Dilatation; Female; Humans; Mifepristone; Misoprostol; Pain, Postoperative; Pregnancy; Pregnancy Trimester, Second

Second-trimester abortions are most commonly performed in the United States via dilation and evacuation; however, there are instances in which the use of systemic abortifacients is necessary. Lack of trained staff to perform late abortion procedures, fetal anomalies, and patient preference are important considerations when selecting the method of termination. Second-trimester abortions with misoprostol-only protocols require higher doses, side effects are more common, and the time to complete the abortion is longer in comparison to mifepristone-misoprostol combinations. Feticidal agents are recommended to avoid transient fetal survival. This chapter will review medical induction methods between gestational ages of 14 and 24 weeks that are commonly used in the United States.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Dilatation; Drug Therapy, Combination; Female; Gynecologic Surgical Procedures; Humans; Maternal Mortality; Mifepristone; Misoprostol; Pain, Postoperative; Pregnancy; Pregnancy Trimester, Second

To perform ambulatorial surgery with local anaesthetics, it is important to carry out a correct postsurgical NSAID therapy avoiding the risks induced by these drugs. Two groups of patients submitted to ambulatorial hemorrhoidectomy were enrolled in a randomized study to evaluate the safety of NSAID therapy with or without the coadministration of misoprostol, a PGE1 analogue with gastroprotective action. Aim of this study was to evaluate if misoprostol in coadministration with NSAID could permit a correct domiciliary postsurgical NSAID therapy without gastric symptoms related to the NSAID therapy. From January 1990 to December 1991, 95 patients underwent hemorrhoidectomy and were discharged with analgesic therapy: the first group (n = 45) without gastroprotective therapy, the second group (n = 50) with the coadministration of misoprostol 200 mcg bid. After 7 and 14 days of treatment patients showed the following symptoms: in the first group 13.3% of the cases showed mild epigastric pain, 8.8% moderate epigastric pain and 4.4% severe epigastric pain with heartburn; in the second group (NSAID + misoprostol) only 4% of the cases showed moderate epigastric pain. The incidence of epigastric pain was statistically higher (p < 0.05) in patients treated with NSAID alone in comparison with the group treated with NSAID + misoprostol. The results, according to international literature, show that correct gastro-protective therapy with synthetic prostaglandins (misoprostol) is necessary for patients in treatment with NSAIDs.

Topics: Adult; Aged; Anal Canal; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Dose-Response Relationship, Drug; Drug Evaluation; Drug Therapy, Combination; Female; Fissure in Ano; Gastric Mucosa; Gastrointestinal Motility; Hemorrhoids; Humans; Male; Middle Aged; Misoprostol; Pain, Postoperative

To evaluate efficacy and satisfaction of dextromethorphan as a non-narcotic adjuvant to current analgesic regimens for medication abortion.. We conducted a randomized, double-blinded, placebo-controlled trial. We randomized eligible participants (N = 156) 1:1 to adjunctively take dextromethorphan (loading dose 60 mg and two subsequent 30 mg doses at 2 and 5 hours after misoprostol administration) or placebo combined with usual-care nonsteroidal anti-inflammatory medications ± opioids for pain. Participants reported pain scores and satisfaction using a secure texting application at 2, 5, 8, and 24 hours after misoprostol administration. Our primary outcome was worst pain score and total analgesic use.. Baseline demographics of enrolled participants were similar between randomization arms. Worst pain scores for participants receiving dextromethorphan versus placebo (8.0 vs 7.0, p = 0.06) did not differ. Total milligram usage of ibuprofen (800 mg vs 610 mg, p =.62), acetaminophen (1000 mg vs 1300 mg, p = 0.62), and opioids (10 mg vs 15 mg, p = 0.51) did not differ between the randomization groups. Participants randomized to placebo were significantly more likely to be satisfied with their pain control (91% vs 75%, p = 0.02).. Dextromethorphan used adjunctively with standard analgesics did not reduce pain associated with medication abortion. Participants who received dextromethorphan reported decreased satisfaction with their pain control.. Dextromethorphan used adjunctively with commonly used analgesic regimens did not reduce medication abortion associated pain. Many participants did not use analgesics as counseled, and nearly 25% used no analgesia during medication abortion.

Topics: Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Dextromethorphan; Double-Blind Method; Female; Humans; Misoprostol; Pain; Pain, Postoperative; Pregnancy

To compare the effect of cervical priming with mifepristone with that of misoprostol on pain perception during surgical induced abortion under paracervical block.. We conducted a randomized, single-blind, two-center study of women undergoing surgical induced abortion at less than 14 weeks of gestation under paracervical block. Participants were randomized to receive cervical priming with 200 mg of oral mifepristone 36 hours or 400 micrograms buccal misoprostol 3 hours before surgery. The primary outcome was pain during mechanical cervical dilation evaluated by a 100-mm visual analog scale (VAS). Secondary outcomes were pain during aspiration, preoperative and postoperative pain, participant satisfaction, duration of the procedure, occurrence of complications, and ease of performing the procedure (assessed by a 100-mm VAS). We estimated that 110 women would have to be included to have 90% power to detect a 13mm-difference of VAS for pain.. Between June 2017 and May 2019, 314 women were eligible and 110 were randomized (55 in each group). Patient characteristics were similar in the two groups. The mean VAS score during mechanical cervical dilation was lower in the mifepristone group (35.6±21 vs 43.5±21, P=.04) as was the mean VAS during aspiration (34±24 vs 47.8±23, P=.003). The preoperative and postoperative mean VAS, satisfaction and duration of procedures were similar between groups. The procedure was significantly easier to perform in the mifepristone group (88±16 vs 80±23, P=.004).. Cervical priming with mifepristone for surgical induced abortion under paracervical block up to 14 weeks of gestation is more effective than misoprostol in reducing pain perception.. ClinicalTrials.gov, NCT03043014.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Anesthesia, Obstetrical; Female; Humans; Mifepristone; Misoprostol; Pain Measurement; Pain, Postoperative; Pain, Procedural; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Single-Blind Method; Young Adult

To evaluate the effectiveness of celecoxib for pain relief and antipyresis during second trimester abortion using sublingual misoprostol.. Fifty-six pregnant women of gestational age 14-24 weeks were randomly assigned in a double-blind randomized controlled trial to receive 400 mg of celecoxib or placebo just before sublingual administration of misoprostol 400 µg every 6 h. Pain and body temperature (BT) were assessed every 1 h until the abortion or 24 h after the first dose of misoprostol. Pain was assessed using a 10-cm Visual Analog Scale (VAS). BT was measured with an infrared thermometer.. From January 2016 through September 2016, 28 patients were randomized into each study group. The mean VAS pain score at the completion of the abortion in the celecoxib group was significantly lower than in the placebo group (4.6 ± 2.8 vs. 7.3 ± 2.2) (p = 0.012). But 42.9% of patients in both groups experienced severe pain and needed equivalent amounts of morphine rescue. The overall mean BT in the celecoxib group was significantly lower than in the placebo group [- 0.09 (SD = 0.04)] (p = 0.017). The mean BTs at 1, 2 and 6 h after each repeated dose of misoprostol in the celecoxib group were also significantly lower than in the placebo group.. Single-dose 400 mg celecoxib had an inadequate beneficial effect on pain relief but significant antipyretic effect during second trimester abortions using sublingual misoprostol.

Topics: Abortion, Therapeutic; Administration, Sublingual; Adult; Anti-Inflammatory Agents, Non-Steroidal; Antipyretics; Celecoxib; Double-Blind Method; Female; Gestational Age; Humans; Misoprostol; Outcome Assessment, Health Care; Pain; Pain Management; Pain Measurement; Pain, Postoperative; Pregnancy; Pregnancy Trimester, Second

To evaluate the reduction of pain by misoprostol compared with placebo prior to hysteroscopy in postmenopausal and premenopausal nulliparous women.. Randomised multicentre double-blind placebo controlled trial.. Two Dutch teaching hospitals and one Dutch university medical centre.. Postmenopausal and premenopausal nulliparous women undergoing office hysteroscopy.. Patients were randomised to receive either 400 microgram misoprostol or placebo 12 and 24 hours before hysteroscopy. Pain was quantified by the use of real time pain measurement using the continuous pain score meter (CPSM) and VAS scores.. Primary outcome was pain measured by the CPSM during passage of the hysteroscope through the cervical canal, quantified by the area under the curve (AUC). Secondary outcomes included VAS scores, other CPSM parameters, failures and side effects.. In all, 149 patients were randomly assigned to either misoprostol (n = 74) or placebo (n = 75). The AUC during introduction did not significantly differ between the intervention and the placebo group. The VAS score during introduction, however, demonstrated a significant difference in premenopausal nulliparous women favouring misoprostol: 2.9 (95% CI 1.3-4.4) versus placebo 5.5 (95% CI 3.9-7.1), P = 0.02, as well as the AUC during the entire procedure: 618 (95% CI 410-827) versus 1126 (95% CI 671-1580), P = 0.04. Failures were equally distributed between the misoprostol (16%) and placebo group (13%). Intestinal side effects occurred significantly more frequently in the misoprostol group (67%) than in the placebo group (32%) [OR 4.2 (95% CI 2.1-8.3), P < 0.01].. Misoprostol prior to hysteroscopy reduces pain in premenopausal nulliparous women but not in postmenopausal women. It does cause side effects.. RCT: misoprostol versus placebo prior to hysteroscopy in 149 women significantly reduces some pain parameters.

Topics: Adult; Ambulatory Surgical Procedures; Cervix Uteri; Double-Blind Method; Drug Administration Schedule; Female; Gastrointestinal Diseases; Humans; Hysteroscopy; Middle Aged; Misoprostol; Operative Time; Oxytocics; Pain Measurement; Pain, Postoperative; Parity; Postmenopause; Premenopause; Preoperative Care; Treatment Outcome

To compare the effectiveness of misoprostol with uterine straightening by bladder distension in minimising the pain experienced by postmenopausal patients during diagnostic office hysteroscopy.. Seventy-six postmenopausal patients were randomly allocated in a 1:1 ratio to the misoprostol group or to the bladder distension group. Patients in the misoprostol group were instructed to insert two misoprostol tablets (400μg) in the vagina 12h before office hysteroscopy. Patients in the bladder distension group were instructed to drink one litre of water and to avoid urination during a period of 2h before office hysteroscopy. The severity of pain experienced by the patients during and at 30min after the procedure was measured using a 100-mm visual analogue scale (VAS). The ease of passing the hysteroscope through the cervical canal was assessed by the hysteroscopists using a 100-mm VAS.. The passage of the hysteroscope through the cervical canal was easier in the misoprostol group [60.37±15.78 vs. 50.05±19.88, p=0.015]. The mean VAS pain score during the procedure was significantly lower in the misoprostol group [39.47±13.96 vs. 50.18±15.44, p=0.002]. The mean VAS pain score 30min post-procedure was comparable between both groups [11.82±3.71 vs. 12.61±4.06, p=0.379].. Vaginal misoprostol is more effective than uterine straightening by bladder distension in relieving the pain experienced by postmenopausal patients during office hysteroscopy.. Clinicaltrials.gov [NCT02328495]. https://clinicaltrials.gov/ct2/show/NCT02328495.

Topics: Administration, Intravaginal; Aged; Analgesia; Female; Humans; Hysteroscopy; Middle Aged; Misoprostol; Oxytocics; Pain Management; Pain, Postoperative; Postmenopause; Severity of Illness Index; Treatment Outcome; Urinary Bladder; Uterus

The objective was to investigate mifepristone as a potential adjunct to cervical preparation for surgical abortion after 19 weeks of gestation, with the aim of improving procedure access, convenience and comfort.. This is a site-stratified, block-randomized, noninferiority trial of 50 women undergoing surgical abortion between 19 and 23 6/7 weeks of gestation randomized to receive either one set of osmotic dilators plus mifepristone the day prior to procedure (mifepristone group) or two sets of osmotic dilators (placed 18-24 h apart) in the 2 days prior to procedure (control group). All subjects received preprocedure misoprostol. Primary outcome was procedure time. Secondary outcomes included preoperative cervical dilation, ease of procedure, and side effects and pain experienced by subjects.. Mean gestational age was similar between groups (20 weeks); more nulliparous subjects were randomized to the mifepristone group (46% vs. 12%, p=.009). Mean procedure times were similar: mifepristone group 11:52 (SD 5:29) vs. control group 10:56 (SD 5:08); difference in means -56s, with confidence interval (95% CI -4:09 to +2:16) not exceeding the 5-min difference we a priori defined as clinically significant. Preprocedure cervical dilation did not differ and was >3cm for the majority of subjects in both groups. There was no difference (p=.6) in ease of procedure reported by providers. Preoperative (postmisoprostol) pain and postoperative pain levels were greater with mifepristone (p = 0.02 and p= 0.04 respectively). Overall subject experience was not different (p=0.80), with most reporting a "better than expected" experience.. Mifepristone with one set of osmotic dilators and misoprostol did not result in longer procedure times or less cervical dilation than serial (two sets) of osmotic dilators and misoprostol, and has the potential to improve access to second trimester abortion without compromising safety.. Use of mifepristone for cervical preparation before surgical abortion after 19 weeks allows for fewer visits and fewer osmotic dilators without compromising cervical dilation or increasing procedure time.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Combined Modality Therapy; Dilatation; Female; Humans; Mifepristone; Misoprostol; Operative Time; Pain, Postoperative; Pregnancy; Pregnancy Trimester, Second; Young Adult

To assess same-day and delayed reports of pain intensity during and after second-trimester medical termination of pregnancy (MTOP).. A prospective randomized trial (217 women) comparing 1- and 2-day mifepristone-misoprostol intervals.. Women reported intense pain [median visual analogue scale (interquartile range)] related to expulsion of the fetus [6 (0-10)]. Delayed reports of maximal pain described the pain as more intense than same-day reports [8 (3-10) vs. 7 (1-10), p<.001].. Most women reported and readily remembered intense pain associated with fetal expulsion during second-trimester MTOP.. Adequate, properly timed pain management during second-trimester MTOP is crucial.

Topics: Abortion, Induced; Adult; Female; Humans; Mifepristone; Misoprostol; Pain Measurement; Pain, Postoperative; Pregnancy; Pregnancy Trimester, Second; Prospective Studies

To evaluate and compare the effectiveness of oral and vaginal misoprostol versus placebo to facilitate office hysteroscopy without anesthesia during infertile diagnostic evaluation.. Randomized, prospective trial.. Patients scheduled for diagnostic office hysteroscopy at a university hospital.. Seventy-five infertile patients scheduled for diagnostic office hysteroscopy.. Patients were divided into three groups: group A received oral misoprostol 600 μg; group B, vaginal misoprostol 400 μg; and group C, oral placebo.. Pain, evaluated by visual analogue scale, and surgical time were recorded and compared. Statistical analysis was done using Student's t-test.. Pain was low in the vaginal misoprostol group. Mean visual analogue scale in the oral misoprostol group was 6.04 ± 1.5; in the vaginal misoprostol group 2.85 ± 1.2; and in the placebo group 7.50 ± 1.5. Procedural time for office hysteroscopy was shorter in the vaginal misoprostol group (2.7 ± 1.0 minutes) compared with group A (5.5 ± 1.1 minutes) and group C (6.3 ± 3.8 minutes).. Vaginal misoprostol, 400 μg, administered the day before office hysteroscopy considerably reduces pain and the time needed for hysteroscopy. This simple strategy may facilitate office hysteroscopy during an infertility work-up.

Topics: Administration, Intravaginal; Adult; Ambulatory Surgical Procedures; Anesthesia; Female; Humans; Hysteroscopy; Infertility, Female; Middle Aged; Misoprostol; Oxytocics; Pain Measurement; Pain, Postoperative; Placebos; Treatment Outcome; Young Adult

To perform ambulatorial surgery with local anaesthetics, it is important to carry out a correct postsurgical NSAID therapy avoiding the risks induced by these drugs. Two groups of patients submitted to ambulatorial hemorrhoidectomy were enrolled in a randomized study to evaluate the safety of NSAID therapy with or without the coadministration of misoprostol, a PGE1 analogue with gastroprotective action. Aim of this study was to evaluate if misoprostol in coadministration with NSAID could permit a correct domiciliary postsurgical NSAID therapy without gastric symptoms related to the NSAID therapy. From January 1990 to December 1991, 95 patients underwent hemorrhoidectomy and were discharged with analgesic therapy: the first group (n = 45) without gastroprotective therapy, the second group (n = 50) with the coadministration of misoprostol 200 mcg bid. After 7 and 14 days of treatment patients showed the following symptoms: in the first group 13.3% of the cases showed mild epigastric pain, 8.8% moderate epigastric pain and 4.4% severe epigastric pain with heartburn; in the second group (NSAID + misoprostol) only 4% of the cases showed moderate epigastric pain. The incidence of epigastric pain was statistically higher (p < 0.05) in patients treated with NSAID alone in comparison with the group treated with NSAID + misoprostol. The results, according to international literature, show that correct gastro-protective therapy with synthetic prostaglandins (misoprostol) is necessary for patients in treatment with NSAIDs.

Topics: Adult; Aged; Anal Canal; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Dose-Response Relationship, Drug; Drug Evaluation; Drug Therapy, Combination; Female; Fissure in Ano; Gastric Mucosa; Gastrointestinal Motility; Hemorrhoids; Humans; Male; Middle Aged; Misoprostol; Pain, Postoperative

In this study, we aimed to evaluate the effect of using two doses of rectal misoprostol on postoperative results in hysteroscopic myomectomy.. This retrospective study was carried out at two hospitals in which the medical records of patients who underwent hysteroscopic myomectomy between November 2017 and April 2022 were evaluated, and subjects were grouped depending on the administration of misoprostol before hysteroscopy. In recipients, two rectal doses of misoprostol (400 μg) were administered, 12 h and 1 h before the planned operation. Outcomes evaluated were: postoperative reduction in hemoglobin (Hb), pain at 12 and 24 h (VAS score), and length of hospital stay.. The mean age of 47 women in the study group was 27.38 ± 5.12 (range 20-38) years. Hb levels reduced significantly in both groups after hysteroscopic myomectomy (p < 0.001). In misoprostol recipients, VAS score was found to be significantly lower at 12 h (p < 0.001) and 24 h after the operation (p = 0.004). Multiple linear regression analyses for each of the outcomes revealed the following: greater myoma size was associated with greater Hb decrease (p = 0.010), misoprostol use was associated with lower 12th and 24th hour VAS scores (p < 0.001), longer duration of operation was associated with higher 12th and 24th hour VAS scores (p < 0.001), and finally, longer duration of operation was associated with prolonged hospital stay (p = 0.001).. The use of two doses of rectal misoprostol before hysteroscopic myomectomy was effective in reducing postoperative pain. Prospective, population-based studies evaluating different uses of misoprostol in hysteroscopic myomectomy are needed.

Topics: Adult; Female; Humans; Hysteroscopy; Leiomyoma; Misoprostol; Pain, Postoperative; Pregnancy; Prospective Studies; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms; Young Adult

To compare the level of pain reported by women by dose of mifepristone, 200 or 600mg, and describe the main factors related to the pain level in the 5 days after a medical abortion.. Observational study in 11 medical centers in France between October 2013 and September 2014. The protocols were 200 or 600mg orally mifepristone on day 1 of the medical abortion and 400, 600 or 800μg orally misoprostol on day 3. Women returned a questionnaire that they completed during 5 days following the abortion; pain was recorded on a visual analog scale (0-10) daily.. 453 women were included; the mean age was 29 years (range 18-49 years). Pain was greater with 200 than 600mg mifepristone: 33% of women reported a pain level of ≥8 on day 3 with 200mg as compared with 16% with 600mg. This difference remained after controlling for age, gestational age, gravidity, usual painful menstruation and misoprostol dose. Percentages of symptoms as vomiting or diarrhea were also lower with 600mg mifépristone than 200mg.. The mean pain severity experienced by women undergoing medical abortion is high; it is higher with a regimen of 200mg mifepristone. The findings emphasize the need to improve analgesic strategies and invite to opt for a protocol of 600mg instead of 200mg mifepristone.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adolescent; Adult; Age Factors; Analgesics; Female; France; Gravidity; Humans; Middle Aged; Mifepristone; Misoprostol; Pain Measurement; Pain, Postoperative; Pregnancy; Surveys and Questionnaires; Young Adult