Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion

<i>A central component of a patient’s abortion experience is pain perception and optimization of pain management choices. Yet, data on patients’ experience of pain and their preferences regarding pain strategies are limited and tend to utilize solely quantitative data. This study utilized a qualitative thematic analysis to identify patient priorities, preferences, and expectations for pain management during first-trimester surgical abortion with nitrous oxide or oral sedation. Thirty-one patients seeking a first-trimester surgical abortion, self-selecting inhaled nitrous oxide (NO) (16 patients), or oral sedation (PO) with oxycodone and Ativan (15 patients) enrolled in this prospective cohort study. Participants provided demographic data, rated procedure pain on a 10 cm visual analog scale (VAS), and participated in semi-structured interviews. We analyzed qualitative data using a content analysis approach. Pre-procedure participants wanted a positive experience. Participants endorsed an ideal analgesic as having a quick onset of action, minimal side effects, no addiction potential, and being effective at reducing pain. After the procedure, there we start differences between priorities in NO and PO participants. NO participants valued the resumption of everyday activities, while PO participants desired ongoing anxiolysis. Anticipatory counseling often mitigated higher procedure pain and more medication side effects than anticipated. Participants emphasized that positive interactions with providers/staff significantly improved their abortion experience. Preemptive comprehensive counseling about procedure and analgesic effectiveness, along with providing options for analgesia, will facilitate an affirmative and patient-centered abortion experience.</i>