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.