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(2017) Evaluation of analgesia by epidural magnesium sulphate versus fentanyl as adjuvant to levobupivacaine in geriatric spine surgeries. Randomized controlled study, Egyptian

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 ¼ 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 À2.38; 95% confidence interval, À4.07 to À0.68). 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. (Fertil Steril Ò 2019;111:553-61. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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