Applied Topical Heat as an Adjunct for Pain Control in First-Trimester Surgical Abortionl

Paracervical blocks are routinely used in first trimester surgical abortions and are a
proven method for decreasing procedural pain. Even when paracervical anesthesia is used, an
overwhelming majority of women still report at least moderate pain during a first trimester
abortion procedure. Other than some non-pharmacologic modalities (music and visualization),
only the addition of intravenous medication has been shown to reduce procedural pain.
Applied topical heat is effective in alleviating pain in other medical subspecialties, and
in gynecology has been shown to reduce pain from dysmenorrhea, but has never been studied
for intraoperative pain control during first trimester abortion.

The investigators plan to conduct a double-blinded, randomized, controlled trial
investigating the utility of topical heat application as an adjunct to paracervical block in
first trimester surgical abortions up to 12 6/7wks. The primary outcome is pain score,
measured using VAS, at time of uterine aspiration. As secondary outcomes, the investigators
will look at the effect of heat application on pain at time of speculum placement,
paracervical block, tenaculum placement, cervical dilation and overall pain. Patient
satisfaction will also be assessed. If found to reduce pain during abortion under local
anesthesia, the use of heat could offer an inexpensive, safe and universally available
adjunct to the paracervical block during this procedure.