Uterine or paracervical lidocaine application for pain control during intrauterine contraceptive device insertion: a meta-analysis of randomised controlled trials

Abstract

Objective: Systematic review and meta-analysis to assess the effects of uterine or paracervical lidocaine application on pain control during IUD insertion.

Methods: PubMed and five other electronic research databases were searched through 15 November 2017 for RCTs comparing lidocaine treatment vs. a control (placebo or no-intervention) to prevent pain during IUD insertion. Searched terms included ‘IUD insertion’, ‘lidocaine’ and ‘randomised controlled trial’. RCTs evaluating lidocaine treatment before IUD insertion without restriction of language, age and IUD type. Pain measured by visual pain scales at tenaculum placement, IUD insertion and immediate post-IUD insertion. Results of random effects meta-analyses were reported as mean differences (MDs) of visual pain scale (VPS) scores and their 95% confidence intervals (CIs).

Results: Eleven RCTs (n = 1458 women) reporting paracervical lidocaine block or uterine mucosa lidocaine application before IUD insertion. Lidocaine produced lower VPS scores during tenaculum placement (MD −0.99, 95% CI: −1.73 to −0.26), IUD insertion (MD −1.26, 95% CI: −2.23 to −0.29) and immediate post-IUD insertion period (MD −1.25, 95% CI: −2.17 to −0.33).

Conclusion: Lidocaine treatment was associated with modest reduction of pain during tenaculum placement and after IUD insertion.

摘要

目的：系统回顾和荟萃分析用于评价子宫或宫颈旁应用利多卡因对IUD置入的止痛效果。

方法：检索了2017年11月15日之前的PubMed和其他5个电子数据库, 获取了比较利多卡因治疗组和对照组（安慰剂或无干预）对于宫内节育器置入时的止痛效果的随机对照试验。检索词包括“宫内节育器置入”, “利多卡因”, “随机对照试验”。无语言、年龄和宫内节育器类型限制的随机对照试验评价了利多卡因在宫内节育器置入前的治疗效果。通过疼痛目测量表在放置窥器、置入宫内节育器和直接置入宫内节育器时评估疼痛程度。随机对照荟萃分析的结果为疼痛直观量表（VPS）评分的标准差（MDs）及其95%置信区间（CIs）。

结果：十一个随机对照试验（n = 1458女性）报告了IUD置入前应用宫颈旁利多卡因阻滞麻醉或子宫内膜利多卡因麻醉。利多卡因在放置窥器（MD -0.99, 95% CI: -1.73至-0.26）、置入IUD（MD -1.26, 95% CI: -2.23至-0.29）及直接置入IUD（MD -1.25, 95% CI: -2.17至-0.33）后的VPS评分均较低。

结论：应用利多卡因可以适当减轻放置窥器及其后置入IUD所带来的疼痛。

Keywords:

• Genital pain
• intrauterine contraceptive device
• IUD insertion
• levonorgestrel intrauterine system
• lidocaine
• pain visual scale
• prilocaine

Acknowledgements

The authors would like to thank to Dr. Y. Karasu for providing additional information from a RCT.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and the writing of the article.