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


CONCLUSIONS
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.
1st Department of Obstetrics and Gynaecology, Athens University, Medical School, Alexandra Hospital , Athens , Greece.
Vasileios
V
Pergialiotis
Dimitrios G
DG
Vlachos
Athanasios
A
Protopappas
Georgios D
GD
Vlachos
D000698:Analgesia / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D008012:Lidocaine / Q000008:administration & dosage; D016595:Misoprostol / Q000008:administration & dosage; D010120:Oxytocics / Q000008:administration & dosage; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D016032:Randomized Controlled Trials as Topic
D000779:Anesthetics, Local; D010120:Oxytocics; D016595:Misoprostol; D008012:Lidocaine
Analgesia; Intrauterine device; Lidocaine; Misoprostol; Pain; Visual analogue scale (VAS)