Nitrous Oxide Compared With Intravenous Sedation for Second-Trimester Abortion A Randomized Controlled Trial

OBJECTIVE: To assess whether inhaled nitrous oxide is noninferior to intravenous (IV) sedation for pain control during outpatient surgical abortion between 12 and 16 weeks of gestation. METHODS: We enrolled women undergoing surgical abortion at 12-16 weeks of gestation into a multisite, double-blind clinical trial. Participants were randomized to sedation with nitrous oxide (70% nitrous/30% oxygen) or IV fentanyl (100 micrograms) and midazolam (2 mg). Paracervical block was administered to both groups. The primary outcome measure was immediate postabortion recall of maximum pain on a 100-mm visual analog scale. RESULTS: Between August 2016 and March 2017, we assessed 170 women for eligibility and enrolled 39, 19 in the nitrous group and 20 in the IV sedation group. Seven participants in the nitrous group (36.8%) required conversion to IV sedation for inadequate pain control. No participants in the IV sedation group required additional medication. The proportion of women requiring additional pain control in the nitrous group exceeded our predefined stopping rule. Intention-to-treat analysis demonstrated that immediate postabortion visual analog scale pain scores were lower by 20.1 mm (95% CI 1.6-38.6) in women randomized to IV sedation than in women randomized to nitrous. CONCLUSION: Intravenous sedation is a better choice than inhaled nitrous oxide for pain control in second-trimester abortion.