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.


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.
['Pergialiotis|Vasileios|V|', 'Vlachos|Dimitrios G|DG|', 'Protopappas|Athanasios|A|', 'Vlachos|Georgios D|GD|']
D000698:Analgesia D000779:Anesthetics, Local D005260:Female D006801:Humans D007434:Intrauterine Devices D008012:Lidocaine D016595:Misoprostol D010120:Oxytocics D010146:Pain D010147:Pain Measurement D019919:Prosthesis Implantation D016032:Randomized Controlled Trials as Topic
Pain Intrauterine device Lidocaine Misoprostol Analgesia Visual analogue scale (VAS)