title: Ketorolac for Pain Control With Intrauterine Device Placement: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To evaluate intramuscular ketorolac compared with placebo saline injection for pain control with intrauterine device (IUD) placement.
  
  
  METHODS
  We conducted a randomized, double-blind, placebo-controlled trial between July 2012 and March 2014. Patients received 30 mg ketorolac or placebo saline intramuscular injection 30 minutes before IUD placement. The primary outcome was pain with IUD placement on a 10-cm visual analog scale. Sample size was calculated to provide 80% power to show a 2.0-cm difference (α=0.05) in the primary outcome. Secondary outcomes included pain with study drug injection, speculum insertion, tenaculum placement, uterine sounding, and at 5 and 15 minutes after IUD placement.
  
  
  RESULTS
  A total of 67 women participated in the study, 33 in the ketorolac arm and 34 in the placebo arm. There were no differences in baseline demographics including age, body mass index, and race. There were no differences in median pain scores for IUD placement in the placebo compared with ketorolac groups (5.2 compared with 3.6 cm, P=.99). There was a decrease in median pain scores at 5 minutes (2.2 compared with 0.3 cm, P≤.001) and 15 minutes (1.6 compared with 0.1 cm, P≤.001) after IUD placement but no difference for all other time points. Nulliparous participants (n=16, eight per arm) had a decrease in pain scores with IUD placement (8.1 compared with 5.4 cm, P=.02). In this study, 22% of participants in the placebo group and 18% in the ketorolac group reported injection pain was as painful as IUD placement.
  
  
  CONCLUSIONS
  Ketorolac does not reduce pain with IUD placement but does reduce pain at 5 and 15 minutes after placement.
  
  
  BACKGROUND
  ClinicalTrials.gov; www.clinicaltrials.gov, NCT01664559.
  
  
  METHODS
  I.
authors.affiliation: Department of Reproductive Medicine, University of California, San Diego, San Diego, California; and the Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Lynn L
authors.initials: LL
authors.lastname: Ngo
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Ward
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Mody
mesh_terms: D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007434:Intrauterine Devices; D020910:Ketorolac / Q000627:therapeutic use*; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac