Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis.

Abstract

OBJECTIVE:

To synthesize the evidence on the most effective medications for the relief of intrauterine device (IUD) insertion-related pain.

DESIGN:

Systematic review and network meta-analysis of randomized controlled trials (RCTs).

SETTING:

Not applicable.

PATIENT(S):

Patients undergoing IUD insertion who received different medications for pain relief versus those who received placebo.

INTERVENTION(S):

Electronic search in the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ScienceDirect.

MAIN OUTCOME MEASURE(S):

Visual analog scale (VAS) pain score during tenaculum placement, IUD insertion, and 5 to 20 minutes after insertion, the score of easiness of insertion and the need for additional analgesics.

RESULT(S):

The present review included 38 RCTs (n = 6,314 patients). The network meta-analysis showed that lidocaine-prilocaine cream (genital mucosal application) statistically significantly reduced pain at tenaculum placement compared with placebo (mean difference -2.38; 95% confidence interval, -4.07 to -0.68). In the ranking probability order, lidocaine-prilocaine cream ranked the highest in reducing the pain at tenaculum placement, followed by lidocaine (paracervical). Similarly, lidocaine-prilocaine cream ranked as the highest treatment in pain reduction during IUD insertion, followed by lidocaine (paracervical).

CONCLUSION(S):

Lidocaine-prilocaine cream is the most effective medication that can be used for IUD insertion-related pain. Other medications are not effective.

• Authors: Ahmed Samy, Ahmed M Abbas, Mostafa Mahmoud, Ayman Taher, Mohamed Hammam Awad, Tarek El Husseiny, Mohamed Hussein, Mohamed Ramadan, Mohamed A Shalaby, Mohamed El Sharkawy, Dina Hatem, Ahmed Alaa-El-Din Wali, Shimaa M Abd-El-Fatah, Amr H Hussein, Hisham Haggag
• Journal: Fertility and sterility (Fertil Steril) Vol. 111 Issue 3 Pg. 553-561.e4 (03 2019) ISSN: 1556-5653 [Electronic] United States
• PMID: 30611553 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anesthetics, Local
• Lidocaine, Prilocaine Drug Combination

Topics

• Administration, Intravaginal
• Anesthetics, Local (administration & dosage, adverse effects)
• Contraception (adverse effects, instrumentation)
• Female
• Humans
• Intrauterine Devices
• Lidocaine, Prilocaine Drug Combination (administration & dosage, adverse effects)
• Pain (diagnosis, etiology, prevention & control)
• Pain Measurement
• Randomized Controlled Trials as Topic
• Treatment Outcome