An Evaluation of Oral Midazolam for Anxiety and Pain in First-Trimester Surgical Abortion: A Randomized Controlled Trial

Lisa L. Bayer, Alison B. Edelman, Rongwei Fu, William Lambert, Mark D. Nichols, Paula H. Bednarek, Kelsey Miller, Jeffrey T. Jensen

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objective: To estimate the effect of oral midazolam on patient pain and anxiety perception during first-trimester surgical abortion. Methods: Between May and December 2013, we conducted a randomized, double-blind, placebo-controlled trial. Patients between 6 0/7 and 10 6/7 weeks of gestation received 10 mg oral midazolam or placebo 30-60 minutes before surgical abortion. All patients received ibuprofen and a paracervical block. We powered the study (power80%; significance level.025) to detect a 15-mm difference in our two a priori primary outcomes of pain and anxiety with uterine aspiration on a 100-mm visual analog scale. Secondary outcomes were pain and anxiety at additional time points, memory, satisfaction, side effects, and adverse events. Results: Demographics were similar between groups (placebo62, midazolam62). Compared with those randomized to placebo, patients who received midazolam had significantly less anxiety preoperatively (room entry: 51.4 mm compared with 34.5 mm, P<.001; positioning: 56.6 mm compared with 45.4 mm, P.02). There was no difference in pain (P.28) or anxiety (P.14) during uterine aspiration or at other procedural time points. A significantly greater number of patients in the midazolam group reported partial amnesia (31/61 compared with 16/61, P.005) and dizziness (30/61 compared with 18/61, P.03). Controlling for baseline differences, patients who received midazolam reported more postoperative sleepiness (P<.001) and less postoperative nausea (P.004). There was no difference in overall satisfaction (P.88). Conclusion: Although oral midazolam reduces preprocedural anxiety, it does not reduce pain or anxiety with uterine aspiration during first-trimester surgical abortions.

Original languageEnglish (US)
Pages (from-to)37-46
Number of pages10
JournalObstetrics and gynecology
Issue number1
StatePublished - Jul 23 2015

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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