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Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network
Ahmed Samy1, Ahmed M Abbas2, Mostafa Mahmoud1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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.
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