Analgesic options for placement of an intrauterine contraceptive: A meta-analysis

作者：Pergialiotis Vasileios^*; Vlachos Dimitrios G; Protopappas Athanasios; Vlachos Georgios D

来源：European Journal of Contraception and Reproductive Health Care, 2014, 19(3): 149-160.

DOI：10.3109/13625187.2014.903238

• Analgesia
• Intrauterine device
• Lidocaine
• Misoprostol
• Pain
• Visual analogue scale (VAS)

Objective Several randomised controlled trials have been published in the last few years which evaluated the efficacy of various analgesics in reducing visual analogue (VAS) pain scores during intrauterine device (IUD) placement. Their results seem to be conflicting and inconclusive.
Methods We searched Medline (1966-2013), Scopus (2004-2013), Clinicaltrials. org (1997-2013), Popline (1973-2013), Cochrane CENTRAL (1999-2013) and Google Scholar (2004-2013) engines for published randomised controlled trials, as well as the reference lists from all electronically retrieved studies.
Results Thirteen studies, involving 1353 women, were finally included in the present meta-analysis. Among the products used, and with respect to their mode of delivery, only paracervical lidocaine was effective in producing lower VAS pain scores related to tenaculum placement (mean difference [ MD]: - 20.54; 95% confidence interval [CI]: - 39.92, - 1.15) and IUD insertion (MD: - 28.99; 95% CI: - 53.14, - 4.84). Misoprostol produced higher VAS pain scores for the immediate post-insertion period (MD: 2.83; 95% CI: - 0.79, 6.45) and it caused various side effects.
Conclusion Paracervical administration of lidocaine prior to IUD insertion reduces VAS pain scores. In view of the small number of studies assessing its efficacy further studies should confirm our findings.

• 出版日期2014-6