Abstract
Study Objective
Intrauterine devices (IUDs) still remain underused in adolescents. Pain during insertion
might prevent adolescents to opt for a levonorgestrel-releasing IUD. This study aimed
to conduct a systematic review, following the Preferred Reporting Items for Systematic
Reviews and Meta-analyses (PRISMA) guidelines, and critically appraise published data
with respect to the efficacy of various substances (analgesics or not) in preventing
pain during levonorgestrel-releasing IUD insertion in nulliparous women as a proxy
for adolescents.
Design, Setting, Participants, Interventions, and Main Outcome Measures
A comprehensive computerized systematic literature search of all English language
studies between 2006 and 2016 was performed in PubMed, EMBASE, Scopus, Evidence Based
Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials),
and Google Scholar. Relevant article reference lists were manually searched.
Results
The computerized database search revealed 31 citations of relevance, 9 of which with
a total of 355 treated women and 345 controls fulfilled the inclusion/exclusion criteria.
In women treated with misoprostol (n = 150) vs placebo (n = 145), the median visual
analogue scale (VAS) score ± SD were 5.7 ± 2.1 vs 5.1 ± 2.2, respectively. In the
previously mentioned population, there was a nonsignificant change in VAS score (odds
ratio, 1.44; 95% confidence interval, 0.86-2.40). In women treated with lidocaine
(n = 140) vs placebo (n = 136), the median VAS score ± SD were 4.6 ± 2.1 vs 5.8 ± 2,
respectively. In the aforementioned population, there was a significant decrease in
VAS score (odds ratio, 0.12; 95% confidence interval, 0.02-0.91).
Conclusion
In nulliparous women, lidocaine treatment seems to be a reasonable choice. However,
further studies are required to examine the different routes and modes of administration
as well as optimal quantities.
Key Words
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Article info
Publication history
Published online: June 08, 2018
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
