***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To study the effects of an intrauterine lidocaine infusion on perceived patient pain in first-trimester abortions and to measure serum lidocaine levels . METHODS : A r and omized , double-blind , placebo control trial of 80 women receiving either a 10-mL 1 % lidocaine ( n = 40 ) or saline ( n = 40 ) intrauterine infusion and a st and ard paracervical block before first-trimester abortion was undertaken . Women completed a series of 100-mm visual analogue scales to measure their perceived pain ( anticipated pain , after speculum insertion , after intrauterine infusion , after cervical dilation , after suction aspiration , and 30 minutes after procedure ) . Twenty women ( 10 in each group ) volunteered for serum lidocaine levels at 10 , 20 , 30 , 45 , and 60 minutes after the lidocaine infusion . RESULTS : Groups were similar in respect to age , parity , prior abortion , ethnicity , gestational age , level of dysmenorrhea , and complications . Pain scores by visual analogue scale demonstrated no significant difference between groups at any time point during the procedure ; in particular , pain during aspiration ( saline infusion 51 ± 26 mm , lidocaine infusion 47 ± 28 mm ; P = .51 ) . Peak serum levels occurred at approximately 10 minutes after lidocaine infusion . The highest level recorded ( lidocaine group ) was 2.5 μg/mL ( toxicity more than 5 μg/mL ) . CONCLUSION : Compared with paracervical block alone , the addition of a 1 % intrauterine lidocaine infusion result ed in no improvement in patient perception of pain during first-trimester abortion . No subjects demonstrated symptoms or serum levels of lidocaine toxicity . LEVEL OF EVIDENCE : Inhalation anaesthesia with halothane was compared with i.v . alfentanil in 66 unpremedicated patients undergoing suction termination of pregnancy as out patients .  Blood loss was significantly greater in the  halothane group with a mean loss of 213 ml , compared with a mean loss of 89.8 ml in the alfentanil group . There was a greater frequency of nausea and vomiting in the alfentanil group , but no reduction in abdominal pain or need for analgesia after operation . Positive relationships were found between blood loss and duration of anaesthesia and between blood loss and gestational age in the halothane group , but not in the alfentanil group . We conclude that alfentanil-supplemented anaesthesia is satisfactory for suction termination of pregnancy when rapid recovery is required or the duration of the procedure is likely to be long , but that halothane anaesthesia can not be recommended , especially if the procedure is long An investigation was undertaken to assess the use of a total intravenous anaesthetic technique offentanyl and methohexilonc for outpatient vaginal termination of pregnancy . When compared with a technique offentanyl , methohexitone , nitrous oxide and trichloroethylene the total intravenous method caused snifter recovery , minimal side‐effects and no cardiovascular depression . However , both anaesthetic techniques produced significant postoperative reduction of memory for new facts when compared with a control group receiving no general anaesthesia . There is a need to continue the search for anaesthetic methods appropriate for day cases OBJECTIVE Our purpose was to assess the effect on pain and patient satisfaction of waiting between paracervical block and dilation during first-trimester abortions . STUDY DESIGN One hundred ninety-nine women seeking pregnancy termination were r and omly assigned to a no-wait group ( group 1 ) and a 3- to 5-minute wait between injection and dilation group ( group 2 ) . Subjects rated their pain on a visual analog scale at four times : prior to procedure , with dilation , with aspiration , and 30 to 45 minutes after procedure . RESULTS No significant differences were observed in pain or satisfaction ratings reported by group 1 ( n = 93 ) and group 2 ( n = 101 ) . A significant decrease in pain with dilation ( 1.21 cm decrease , P = .009 ) and aspiration ( 1.15 cm decrease , P = .0015 ) was observed among patients who received fentanyl . CONCLUSION Delay between paracervical injection and dilation during first-trimester abortion does not have an impact on patient pain or satisfaction .  Fentanyl decreased pain scores by 20 % to 25 % during the procedure OBJECTIVE This report describes an open r and omized study that aims to determine whether a brief hypnotic intervention during first-trimester surgical abortion reduces requests for pain medication . METHODS Thirty women undergoing first-trimester surgical abortion at the family planning clinics of a large hospital in Quebec City were r and omized into a control group that received st and ard care and a hypnosis group that received , in addition to st and ard care , an intervention of hypnosis , including analgesia suggestions 20 min before and throughout the surgical procedure . Patients in both groups were given the option to control their pain with nitrous oxide ( N(2)O ) sedation administered through a nose mask as often and for as long as they wanted during the procedure .  N(2)O sedation  as the primary outcome was assessed at each step of the procedure . The patient 's self-reported anxiety and pain were also assessed during the procedure as secondary outcomes . RESULTS Thirty-six percent of patients in the hypnosis group requested N(2)O sedation during the procedure versus 87 % in the control group ( p<.01 ) . No differences between the groups were found in reports of pain and anxiety during the procedure . CONCLUSION These results suggest that hypnosis can be integrated into st and ard care and reduces the need for N(2)O in patients undergoing first-trimester surgical abortion . This reduction in N(2)O consumption did not lead to significant changes in pain or anxiety , and a larger sample size is required to assess the possible effects of hypnosis on those variables Abstract . In 136 patients , who underwent induced abortion by the vacuum curettage method under local anaesthesia ( paracervical block ) , the effect of 10 mg diazepam intravenously as preoperative sedative was investigated for its ability to abolish the subjective experience of pain . The trial was carried out as a paired sample , r and om allocation , double‐blind , fixed dose trial , and the statistical method was sequential analysis . Thirty‐six pairs showed no difference and were excluded . After 32 pairs ( 24 A preferences and 8 O preferences ) , diazepam showed a significant superiority to placebo ( p<0.05 ) ( Fig. 1 . ) Amnesia for the procedure was reported by about one‐quarter of the diazepam‐treated patients , and in practically all cases the sedative effect had subsided 1–3 hours after the operation One hundred and one patients undergoing outpatient abortion using local anesthesia were r and omly allocated to one of three different premedications : morphine-scopolamine , pethidine or midazolam . The incidence of pain , anxiety , emetic ( nausea-vomiting ) and patient cooperation was analyzed . Discomfort was frequently noticed , 79 patients reported pain , 57 nausea and 26 vomited at least once during the postoperative period which lasted 2.6 h ( mean value ) . There were no major differences in complaints among the different premedication groups . Nausea , though , was correlated to pain . Symptoms of pain , nausea and vomiting were frequent after abortion under paracervical block . These complaints were not found to be related to the type of premedication or other circumstances in the perioperative period The authors evaluated preoperative sedation , intraoperative analgesia , and psychometric integrity resiliency of 98 female patients who underwent voluntary interruption of pregnancy . These women , with a mean age of 27.5 years ( range of 19 - 35 ) received Clotiazepam or Flunitrazepam during the preanesthesia . The patients were administered the Zazzo " deux barrages " test . The 1st 2 parameters did not show any difference between the groups , whereas the patients treated with Clotiazepam  recovered their pschometric abilities significantly more quickly than the patients treated with Flunitrazepam . Side effects were mild , equally present in both groups , and likely attributable to the intraoperative medication . The results suggest that short 1/2-life benzodiazepines like Clotiazepam are 1st choice drugs for the preanesthesia of short surgical operations OBJECTIVE To reduce the pain experienced during abortion . METHODS A four-phase study was conducted at a free-st and ing abortion clinic . Phase 1 : a double-blind , r and omized , placebo-controlled trial of 600 mg ibuprofen given preoperatively was carried out in 193 women .  Pain during the procedure and 30 min postoperatively was compared . Phase 2 : a double-blind , r and omized trial compared 1 % lidocaine , buffered 1 % lidocaine and 0.25 % bupivacaine in terms of the pain of the injection and the pain of the procedure in 200 women . Phase 3 : waiting times of 0 , 3 and 10 - 20 min between the end of the injection and the beginning of the procedure were compared in terms of pain during the procedure in 139 women . Phase 4 : local anesthetic was injected into one side of the cervix slowly and one side quickly and the pain of the injections was compared in 87 women . RESULTS Phase 1 : ibuprofen  reduced pain scores more than placebo with the improvement being greatest for the postoperative period . Phase 2 : buffered lidocaine was significantly less painful to inject than plain lidocaine or bupivacaine . Phase 3 : waiting between the injection and the procedure did not improve pain control . Phase 4 : slower injections were found to be less painful than fast injections . CONCLUSIONS Several methods were found to improve pain control during abortions BACKGROUND This study evaluated the effectiveness of local lignocaine gel application in pain control during first-trimester suction termination of pregnancy ( STOP ) . METHODS In this prospect i ve r and omized placebo-controlled double-blind trial , 131 women undergoing STOP between 7 and 10 weeks of gestation were studied . They were computer-r and omized to receive 2 % lignocaine gel or placebo ( KY Jelly ) locally applied to the cervix 1 min before cervical manipulation/dilatation . They all had cervical priming with misoprostol and premedication with diazepam and pethidine .  Pain scores on a verbal analogue scale preoperative , at cervical manipulation/dilatation , intraoperative and 1 h post-operative , as well as the patients ' satisfaction level towards pain control , were compared . RESULTS The lignocaine gel group had significantly reduced overall intraoperative pain score compared with placebo group ( P = 0.021 ) . No significant difference in pain score between the two groups was demonstrated at other time points . Subgroup analysis revealed that the difference in overall intraoperative pain scores between the two groups was evident in the multiparous ( P = 0.015 ) but not the nulliparous subjects . CONCLUSION The use of local lignocaine gel application reduces overall intraoperative pain in multiparous women undergoing first-trimester STOP preceded by misoprostol cervical priming and premedication for conscious sedation In a r and omized study of 100 women ( ASA 1 - 2 ) undergoing termination of pregnancy as out patients , the combination of midazolam-fentanyl-nitrous oxide was compared with thiopentone-fentanyl-nitrous oxide . The induction time ( the time recorded until disappearance of the palpebral reflex ) was significantly longer in the midazolam group ( 40 s ) than in the thiopentone group ( 31 s ) . There were no significant differences in heart rate or arterial pressure between the two groups . Thirty minutes after the termination of surgery the degree of awareness , estimated by means of Glasgow Coma Scale , was lower in the midazolam group . After 60 and 180 min the scores were equal . During recovery more patients experienced side-effects in the thiopentone group than in the midazolam group , the difference being statistically significant 72 h after discharge when 66 % and 34 % of the patients complained of side-effects , respectively . Midazolam is as suitable as thiopentone for the induction of anaesthesia in day-case surgery One hundred and twenty patients undergoing early legal termination of pregnancy by dilatation and suction curettage before 12 weeks of pregnancy were r and omly allocated to receive total intravenous propofol anaesthesia either alone or supplemented with fentanyl 1.5 μg·kg‐1 or alfentanil 15 μg kg‐1 . Supplementation with fentanyl or alfentanil improved operating conditions ( P<0.01 ) , reduced total propofol requirements ( P < 0.01 ) and reduced postoperative pain intensity ( P < 0.05 ) . Immediate recovery , assessed by the time patients took to open the eyes , to give correct date of birth and by co – operation score , was more rapid in the alfentanil group compared to the control group ( P < 0.05 ) , whereas there was no significant difference between the alfentanil and fentanyl groups . The three anaesthetic techniques did not differ with regard to side effects Many patients present to day surgery clinics for vaginal termination of pregnancy , a procedure which is frequently complicated by postoperative abdominal pain . We have assessed the effic 
    Output:
    
Pain scores during dilation and aspiration were improved with deep injection ( WMD -1.64 95 % CI -3.21 to -0.08 ; WMD 1.00 95 % CI 1.09 to 0.91 ) , and with adding a 4 % intrauterine lidocaine infusion ( WMD -2.0 95 % CI -3.29 to -0.71 , WMD -2.8 95 % CI -3.95 to -1.65 with dilation and aspiration respectively).PCB with premedication : Ibuprofen and naproxen result ed in small reduction of intra- and post-operative pain .
Analgesia : Diclofenac-sodium did not reduce pain .
Conscious sedation : The addition of conscious intravenous sedation using diazepam and fentanyl to PCB decreased procedural pain .
Inhalation anesthetics are associated with increased blood loss (p<0.001).GA with premedication : The COX 2 inhibitor etoricoxib , the non-selective COX inhibitors lornoxicam , diclofenac and ketorolac IM , and the opioid nalbuphine were improved postoperative pain .
Non-pharmacological intervention : Listening to music decreased procedural pain .
No major complication was observed .
Conscious sedation , GA and some non-pharmacological interventions decreased procedural and postoperative pain , while being safe and satisfactory to patients .