This randomized double-masked superiority trial investigates the difference in perceived pain from osmotic dilator placement using a paracervical block of combined ketorolac and lidocaine compared to ibuprofen and paracervical block with lidocaine alone in patients desiring D&E at 16-24 weeks gestation. 76 patients who are seeking procedural abortion or management of fetal demise with D&E and who require osmotic dilator placement for cervical preparation will be recruited. Pain before, during, and after osmotic dilator placement will be measured by participants using an 11-point numerical rating scale (NRS). The primary outcomes are median change in NRS from speculum placement to 5- and 30-minutes post osmotic dilator insertion. Secondary outcomes include pain score change at other time points in the 6 hours after insertion of osmotic dilators, physician-rated ease of dilator insertion and interpretation of patient discomfort, and patient satisfaction with over-all pain control.