Analgesic efficacy of local anesthesia during thyroid fine-needle aspiration biopsy: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials

Figures & data

Table 1. The exact literature search strategy used in every database.

(1) PubMed All Fields: (“fine-needle aspiration” OR “fine needle aspiration” OR FNA OR FNAB OR “fine needle aspiration biopsy” OR FNAC OR “fine needle aspiration cytology”) AND (“local anesthesia” OR lidocaine OR prilocaine OR EMAL OR “lidocaine-prilocaine” OR lignocaine OR xylocaine).

(2) Scopus Article title, Abstract, Keywords: (“fine-needle aspiration” OR “fine needle aspiration” OR FNA OR FNAB OR “fine needle aspiration biopsy” OR FNAC OR “fine needle aspiration cytology”) AND (“local anesthesia” OR lidocaine OR prilocaine OR EMAL OR “lidocaine-prilocaine” OR lignocaine OR xylocaine).

(3) Web of Science All Fields: (“fine-needle aspiration” OR “fine needle aspiration” OR FNA OR FNAB OR “fine needle aspiration biopsy” OR FNAC OR “fine needle aspiration cytology”) AND (“local anesthesia” OR lidocaine OR prilocaine OR EMAL OR “lidocaine-prilocaine” OR lignocaine OR xylocaine).

(4) Cochrane CENTRAL Title Abstract Keyword: (“fine-needle aspiration” OR “fine needle aspiration” OR FNA OR FNAB OR “fine needle aspiration biopsy” OR FNAC OR “fine needle aspiration cytology”) AND (“local anesthesia” OR lidocaine OR prilocaine OR EMAL OR “lidocaine-prilocaine” OR lignocaine OR xylocaine).

(5) Google Scholar All Fields: (“fine-needle aspiration” OR “fine needle aspiration” OR FNA OR FNAB OR “fine needle aspiration biopsy” OR FNAC OR “fine needle aspiration cytology”) AND (“local anesthesia” OR lidocaine OR prilocaine OR EMAL OR “lidocaine-prilocaine” OR lignocaine OR xylocaine).

Figure 1. PRISMA flow diagram for screening process and study selection.

Table 2. Summary of the included trials.

Study ID	Study design	Country	Total sample size, n (intervention/control)	Trial arms		Type of administration
				Local anesthesia	Control
Demirci et al. 2008	RCT	Turkey	n = 50 (25/25)	EMLA 5% (lidocaine-prilocaine)	Placebo	Cream
Gursoy et al. 2006	RCT	Turkey	n = 107 (55/52)	Lidocaine 0.3 ml	Placebo	Injection
Gursoy et al. 2007	RCT	Turkey	n = 99 (50/49)	EMLA 5% (lidocaine-prilocaine)	Placebo	Cream
Gursoy et al. 2009	RCT	Turkey	n = 138 (68/70)	EMLA 5% (lidocaine-prilocaine)	Lidocaine 0.3 ml	Cream and injection
Kim et al. 2009	RCT	South Korea	n = 50 (50/50)	Lidocaine 2%	Nothing	Injection

Abbreviation: LA= local anesthesia, RCT= randomized controlled trial.

Table 3. Baseline characteristics of the included trials.

Study ID	Group	Sample size	Age (years)	Sex, n[male/female]	Nodule size (mm)	Thyroid volume (ml)
Demirci et al. 2008	EMLA	n = 25	50.89 ± 12.01	[0/25]	27.33 ± 10.18	Not reported
	Control	n = 25	47.45 ± 11.61	[0/25]	23.47 ± 8.04	Not reported
Gursoy et al. 2006	Lidocaine	n = 55	50.3 ± 12.9	[45/10]	19.9 ± 7.9	22.6 ± 10.2
	Control	n = 52	46.5 ± 12.9	[45/7]	19.2 ± 6.5	22.4 ± 11.9
Gursoy et al. 2007	EMLA	n = 50	51.6 ± 11.1	[44/6]	20.7 ± 10.9	21.6 ± 9.2
	Control	n = 49	46.8 ± 13.1	[41/8]	18.5 ± 5.8	22.4 ± 11.9
Gursoy et al. 2009	EMLA	n = 68	47.5 ± 9.9	[13/55]	18.3 ± 7.6	20.8 ± 9.8
	Lidocaine	n = 70	50.1 ± 12.1	[12/58]	20.6 ± 10.6	22.1 ± 10.1
Kim et al. 2009	Lidocaine	n = 50	49.3 ± 9.8	Not reported	13.6 ± 4.10	Not reported
	Control	n = 50	49.3 ± 9.8	Not reported	13.0 ± 3.9	Not reported

Figure 2. Risk of bias summary.

Figure 3. Meta-analysis of pain severity assessed by 100-mm visual analogue scale (VAS).

Figure 4. Meta-analysis of pain severity assessed by 11-point numerical rating scale (NRS).

Data availability statement

All data is available within the manuscript.