Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis

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.