Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study

Objective: To determine the efficacy of a nonsteroidal anti-inflammatory drug vs. paracetamol in pain relief during medical abortion and to evaluate whether nonsteroidal anti-inflammatory drugs interfere with the action of misoprostol. Design: A prospective double-blind controlled study. Setting: University-affiliated tertiary hospital. Patient(s): One hundred twenty women who underwent first-trimester termination of pregnancy. Intervention(s): Patients received 600 mg mifepristone orally, followed by 400 μg of oral misoprostol 2 days later. They were randomized to receive ibuprofen or paracetamol when pain relief was necessary. Patients completed a questionnaire about side effects and pain score and returned for an ultrasound follow-up examination 10-14 days after medical abortion. Main Outcome Measure(s): Success rates, as defined by no surgical intervention, and pain scores were assessed. Result(s): Ibuprofen was found to be statistically significantly more effective for pain relief after medical abortion compared with paracetamol. There was no difference in the failure rate of medical abortion, and the frequency of surgical intervention was slightly higher in the group that received paracetamol (16.3% vs. 8.5%). Conclusion(s): Ibuprofen was found to be more effective than paracetamol for pain reduction during medical abortion. A history of surgical or medical abortion was predictive for high pain scores. Despite its anti-prostaglandin effects, ibuprofen use did not interfere with the action of misoprostol.