SALSA: self-administered lidocaine gel for pain management with first trimester surgical abortion: A randomized controlled trial
Awarded 2015
Complex Family Planning Fellowship Research
Jennifer Conti, MD, MS
Stanford University

Abortion remains one of the most common surgical procedures in the world. In the United States, at least half of all women will experience an unintended pregnancy by age 45, and one third of all women will have had an abortion by this same age. Despite universal efforts to increase the comfort of these procedures, pain remains an important limiting factor in where and how abortion is performed.
The objective of this study was to compare pain control at various time points during first trimester surgical abortion using a locally applied, patient-administered lidocaine gel as compared to the traditional lidocaine paracervical lidocaine block. We hypothesized that patients who received lidocaine gel 20-30 minutes prior to their procedure would have pain control equivalent to that of a traditional paracervical block.
We conducted a randomized controlled trial of women undergoing surgical abortion at less than 12-weeks gestation in an outpatient clinic setting. Participants were randomized to receive 12 ml of a 1% lidocaine paracervical block (PCB) or 20 ml of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. Their pain was measured at several time points throughout the procedure using a visual analog pain scale scale (VAS), and these numbers were compared between the two groups.
We enrolled 142 women total in the study and found that there were no differences in the average pain scores between groups at our primary outcome time point (time of cervical dilation). Likewise, there was no statistically significant difference in average (mean) pain scores at any of the other time points measured throughout the procedure.
These findings show that a self-administered lidocaine gel prior to first-trimester surgical abortion is non-inferior to the traditional paracervical lidocaine block, and should be considered as an alternative, non-invasive approach for these procedures. Our findings are also promising as many other non-abortion procedures within gynecology employ the use of a paracervical block. We are currently expanding our study to include the use of this gel for intrauterine device (IUD) insertions and endometrial biopsies—two procedures which can also be quite painful for patients without the use of any pain medication.