Drug  (Class) Dose Range Comment
Local Anesthesia and Additives
Lidocaine (Xylocaine)
(0.5% – 1%)
Most common 100- 200 mg (20 mL 1% or 40 mL 0.5%), maximum dose 300 mg Most common in U.S.  Lower concentration as effective but more expensive
Bacteriostatic Saline 20 mL Less effective than lidocaine
Bicarbonate Buffer 1mL / each 10mL of lidocaine Less injection pain and faster absorption; only for use with lidocaine
Vasopressin (Vasostrict) 3-5 units mixed with anesthetic Decreases bleeding & slows systemic absorption; do not recommend more than 5 units total
Oral and IV Pain Medications
Ibuprofen (Motrin; Advil) 600 – 800 mg PO More effective at least 30 minutes before procedure
Naproxen (Naprosyn; Aleve) 250 – 500 mg PO More effective at least 30 minutes before procedure
Acetaminophen 500 – 1000 mg PO Can be added to PO regimen (limited evidence based data)
Hydrocodone or Codeine 1-2 tablets of 5mg hydrocodone or
or 30 mg codeine PO
Equivalent medications can also be used or those combined with acetaminophen
Fentanyl (Sublimaze) 50 – 100 μg IV Give over 30-60 seconds. Antidote is naloxone
Lorazepam (Ativan) 0.5–2mg mg SL or 1-2 mg PO Shorter acting benzodiazepine. Antidote is flumazenil
Diazepam (Valium) 5 –10 mg PO Longer acting benzodiazepine. Antidote is flumazenil
Midazolam (Versed) 1 – 2 mg IV Give over 30-60 seconds. Antidote is flumazenil
Uterotonics for Post-Aspiration Hemorrhage
Methylergonovine (Methergine) 0.2 mg PO/IM or intracervical Use with caution in hypertensive patients
Misoprostol (Cytotec) 800mcg SL or
800-1000mcg PR
Given a rapid time to peak concentration, SL or buccal may be preferable to PR if possible (Kerns 2013)
Carboprost (Hemabate)* 0.25 mg IM, may repeat at 15-90 minute intervals to max of 2mg Use with caution in asthmatic patients
* Not available for use outside inpatient medical facilities
Oxytocin (Pitocin) 10 u IM, or 10-40 u IV in crystalloid, or 10 u IVP More uterine oxytocin receptors > 20 weeks
Emergency Medications
Atropine Sulfate (Atropen) 0.2 mg (0.5 mL) IV push or 0.4 mg (1 mL) IM, each 3-5 min to max dose of 2 mg For prolonged symptomatic bradycardia with vasovagal
Some use in paracervical block to prevent vasovagal
Diphenhydramine (Benadryl) 25 – 50 mg IM/IV/PO For allergic reaction
Use PO for mild symptoms and IM/IV for anaphylaxis
Epinephrine 1:1000 (Adrenalin) 0.3 – 0.5 mg (1 mg/mL) SQ/IM
Repeat doses at 5-15 min intervals as necessary
For anaphylaxis.  Preferable to inject in mid-anterolateral thigh
Naloxone (Narcan) 0.1 mg – 0.2 mg (0.25-0.50 mL) IV / IM each 2-3 min
Max dose 0.4 mg
Opiate antidote
Flumazenil (Romazicon) 0.2 mg (2 mL) IV each min
Max dose of 1 mg
Benzodiazepine antidote

Alternative or supplemental options for pain management can include ketamine IV, dexmedetomidine IV, gabapentin (Gray 2019), and nitrous oxide (Singh 2017). However limited data on pain improvement with use.   


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