Refining Paracervical Block Techniques for Pain Control in First Trimester Surgical Abortion

Inclusion Criteria: * age 18 years or older * voluntarily requesting pregnancy termination * ultrasound-confirmed intrauterine pregnancy up to 10 6/7 weeks gestational age * generally healthy * English or Spanish speaking * able or willing to sign an informed consent and agree to terms of the study Exclusion Criteria: * gestational age over 10 6/7 weeks (due to routine use of misoprostol starting at this gestational age at the study sites) * incomplete abortion * failed medical abortion * required or requested IV sedation (prior to randomization) * patient who declines Ibuprofen, Lorazepam or PCB * medical contraindication or allergy to any of the study medications * chronic use of narcotic pain medication or heroin * significant physical or mental health condition * adnexal mass or tenderness on pelvic exam consistent with inflammatory disease * known hepatic disease * women who, in the opinion of the investigator, are not suitable for the study protocol