Despite the widespread use of osmotic dilators for cervical preparation for dilation and evacuation, there are minimal data regarding patient pain management during dilator placement.This will be a randomized, double- blind, placebo-controlled trial including women aged 18-50 years with a live intrauterine pregnancy between the gestational ages of 17w0d and 23w5d presenting for cervical dilator placement prior to their dilation and evacuationprocedure.
The proposed randomized control trial will involve 3 arms. Participants in all 3 arms will receive our institution’s current standard analgesia for cervical dilator placement: oral ibuprofen (600 mg given 30 minutes prior to the procedure) and a paracervical block involving 20 ccs of 1% lidocaine medication prior to dilator placement. In addition to the standard regimen, participants will be randomized to receive either an oral dose of placebo, 1mg of Ativan with 5 mg of oxycodone, or 2 mg of Ativan with 10 mg of oxycodone 30 minutes prior to the procedure.
The primary outcome to be assessed will be pain scores using a visual analog scale. Secondary outcomes include patient anxiety, satisfaction, and adverse events and side effects following the procedure. We will also be evaluating cervical dilation at time ofdilation and evacuation once the dilators are removed.