Opioid Prescription For Pain After Osmotic Dilator Placement In Abortion Care: A Randomized Controlled Trial

Abstract [from journal]

Objective: To compare the overnight maximum pain scores after osmotic dilator placement prior to a dilation and evacuation (D&E) procedure in participants assigned to a prescription for ibuprofen alone or to ibuprofen plus oxycodone.

Study design: We conducted a non-blinded pragmatic, randomized controlled trial to evaluate pain management among women undergoing osmotic dilator placement prior to D&E. We randomly assigned 70 participants at 12 weeks 6 days to 23 weeks 6 days gestation to receive a prescription for ibuprofen alone, or ibuprofen plus oxycodone. We assessed pain using a numeric rating scale (NRS; scale 0-10) at the following time points: baseline, dilator placement, 2 and 6 hours, and pre-operatively, where we also asked participants their maximum pain score. The primary outcome was mean individual NRS pain score change from baseline to maximum pain score.

Results: Maximum mean pain score (change from baseline) was 4.7± 2.9 in the ibuprofen group, and 6.5± 2.5 in the ibuprofen plus oxycodone group (p<0.01). Participants in both groups reported highest NRS pain scores 2 hours after dilator placement, 3.9 ±2.5 and 5.3±2.6 respectively (p=0.02). Average ibuprofen use in both arms was similar, and 81% of participants used at least 1 dose of ibuprofen after dilator placement. Of those randomized to prescription to ibuprofen plus oxycodone, only 51% used a dose of oxycodone.

Conclusions: Compared to participants randomized to receive a prescription for ibuprofen, those randomized to receive a prescription for ibuprofen plus oxycodone reported higher maximum overnight pain scores.