Please select the eligibility criteria that correspond to the clinical trial below.
Title: Paracervical Block With Ketorolac and Lidocaine in First Trimester Surgical Abortions
Brief Summary: The investigators primary objective is to study the analgesic effects of combined ketorolac and lidocaine in a paracervical block compared to preoperative ibuprofen followed by intra-operative paracervical block with lidocaine alone on women undergoing first trimester surgical abortions. The investigators hypothesize that women who receive a paracervical block of combined ketorolac and lidocaine will experience less pain during the procedure based on a visual analog scale (VAS) compared to those who receive preoperative ibuprofen and a paracervical block with lidocaine alone.

This randomized, multi-site, placebo-controlled clinical trial will investigate the difference in perceived pain from first trimester surgical abortions using a paracervical block of combined ketorolac and lidocaine compared to preoperative ibuprofen and paracervical block with lidocaine alone. A total of fifty women who are seeking elective surgical abortions of intrauterine pregnancies less than 11 0/7 weeks' gestation will be recruited from Johns Hopkins Bayview Medical Center, Planned Parenthood of Maryland in Baltimore, Maryland and Planned Parenthood Columbia-Willamette in Portland, Oregon. Pain before, during, and after surgical abortion will be measured using a 100-mm VAS.

The primary outcome of interest is the mean difference in pain level from preoperative baseline to time after cervical dilation comparing the treatment groups. If the investigators see greater pain reduction associated with the paracervical block of lidocaine and ketorolac, adoption of this regimen may improve pain management during first trimester surgical abortions. If combined ketorolac and lidocaine when administered as a paracervical block is proven to be efficacious, the need for additional analgesia in first trimester surgical abortions can be minimized.


Options:
A: Inclusion Criteria:

* Women \>=18 years-old
* Presenting for a surgical abortion
* No contraindication to outpatient abortion
* No contraindication to gabapentin
* Fluency in English and able to provide informed consent

Exclusion Criteria:

* Allergy, sensitivity or contraindication to gabapentin
* Severe renal disease
* Currently using gabapentin or pregalabin
B: Inclusion Criteria:

* Aged 18 years or older
* Voluntarily requesting surgical pregnancy termination
* Pregnancy with intrauterine gestational sac between 6 0/7 and 10 6/7 weeks gestation, dated by ultrasound
* Eligible for suction aspiration
* English or Spanish speaking
* Good general health
* Able and willing to give informed consent and agree to terms of the study
* Have assistance home; no driving for 24 hours

Exclusion Criteria:

* - Gestational ages 11 0/7 weeks or more
* Gestational age less than 6 0/7 weeks
* Incomplete abortion
* Premedication with misoprostol
* Use of narcotic pain or anti-anxiety medication within past 24 hours
* Use of heroin or methadone within last 3 months
* Chronic alcoholism or alcohol intoxication within past 24 hours
* Requested narcotics or Intravenous sedation (prior to randomization)
* Allergic reaction or allergy to cherry/cherry flavoring or lidocaine or non-steroidal anti-inflammatory drugs (NSAIDs)
* Allergic reaction or sensitivity to benzodiazepines including hyperactive or aggressive behavior (paradoxical reaction)
* Medical problem necessitating inpatient procedure
* Untreated acute cervicitis or pelvic inflammatory disease
* Known acute narrow-angle glaucoma
* Weighing less than 100 lb (45 kg)
* Use of potent medications interfering with microsomal metabolism within past 48 hours (carbamazepine (Tegretol), cimetidine (Tagamet), diltiazem (Cardizem), erythromycin, fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), phenobarbital, phenytoin (Dilantin), nelfinavir, ranitidine (Zantac), rifampin (Rifadin), ritonavir (Norvir), saquinavir, verapamil (Calan))
C: Inclusion Criteria:

* 18 years old or older,
* elective pregnancy termination at gestational age of less than 11 weeks,
* speak English
* candidate for an in-clinic procedure.
* desire local anesthesia, ibuprofen, Vicodin and Ativan (the usual treatment in our clinic) for managing pain

Exclusion Criteria:

* no medical problems preventing the use of nitrous oxide
* no allergies to nitrous oxide, lidocaine, vasopressin, ibuprofen, Vicodin or Ativan
* significant active upper respiratory infection
* chronic obstructive pulmonary disease (COPD)
* intoxication
* use of street drugs
D: Inclusion Criteria:

* age greater than or equal to 18 years
* English-speaking
* ability and willingness to sign the informed consent
* ability and willingness to comply with the terms of the study
* voluntary request for pregnancy termination
* ultrasound-confirmed singleton intrauterine pregnancy with an estimated gestational age not exceeding 76 days (10 6/7 weeks) from the first day of the preceding menstrual cycle

Exclusion Criteria:

* women who require or request sedation
* untreated acute cervicitis or pelvic inflammatory disease
* contraindications to lidocaine such as allergy to lidocaine, cardiac arrhythmia or heart block, and porphyria
* allergic reaction or sensitivity to lorazepam or NSAIDs
* chronic NSAID use
* history of gastritis or gastric ulcer
* acute renal failure or chronic renal disease
* chronic liver disease
* history of bleeding diathesis
* chronic narcotic use
* current or past history of illegal drug use (excluding marijuana)

Answer: D