Comparison of the Analgesic Effects of Oral Tramadol and Naproxen Sodium on Pain Relief During IUD Insertion

Karabayırlı, Safinaz; Ayrim, Aylin; Muslu, Bünyamin

doi:10.1016/j.jmig.2012.04.004

Cited by 38 publications

(25 citation statements)

References 13 publications

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“…20 It was observed that tramadol and naproxenin mitigated pain in some specific groups. 21 It was shown that use of topical lidocaine 2% gel did not have any effect on the pain scores after tenaculum placement, application and procedure in IUD insertion. 22,23 Nevertheless, there are studies being published which show that topical use of different formulations involving high concentrations of lidocaine mitigates IUD insertion pain at every step of the procedure.…”

Section: Discussionmentioning

confidence: 98%

Intrauterine levobupivacaine for pain control during intrauterine device insertion

Akgün

Keskin

Kalem

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Safe, effective, long term and a reversible contraception method is offered by intrauterine devices (IUDs). The objective was to determine the potency of intrauterine administration of 5 cc levobupivacain for pain relief with IUD insertion, when compared with saline placebo.Methods: This was a prospective randomized, double blind placebo-controlled trial undergoing İUD insertion. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine. Our primary outcome was self-reported pain scores on a 10 cm visual analogue scale (VAS) immediately following IUD insertion.Results: 95 women were enrolled, and data for 88 women were analyzed. In IUD insertion procedure, no difference was observed between groups during teneculum placement and solution administration, in the course of VAS scores (p=0.349, p=0.396). There was a significant difference in the VAS scores measuring pain suffering during and after IUD procedure (p=0.001).Conclusions: Intrauterine instillation of 5 cc of levobupivacaine along with saline solution reduces pain with IUD insertion when compared to intrauterine saline placebo. Broad deviation in pain scores and persistent pain after IUD insertion recommends that patient would benefit from more functioning method of pain control than before at IUD insertion and during the post interval.

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Section: Discussionmentioning

confidence: 98%

Intrauterine levobupivacaine for pain control during intrauterine device insertion

Akgün

Keskin

Kalem

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…Of note, this trial was published after the start of the present trial. 13 A trial of naproxen sodium 300mg with the Dalkon Shield IUD did not reduce pain with placement, but did reduce pain medication requirement post-procedure. 14 Naproxen sodium may have demonstrated efficacy because sufficient time was given for onset of analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…Oral naproxen sodium taken 1 hour prior to IUD placement may decrease pain with placement. 13,14 However, waiting 1 hour may not be possible in a busy clinic.…”

Section: Introductionmentioning

confidence: 99%

Ketorolac for Pain Control With Intrauterine Device Placement

Ngo

Ward

Mody

2015

Obstetrics & Gynecology

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Objective To evaluate intramuscular ketorolac compared to placebo saline injection for pain control with intrauterine device (IUD) placement. Methods We conducted a randomized, double-blind, placebo controlled trial between July 2012 and March 2014. Patients received ketorolac 30mg or placebo saline intramuscular injection 30 minutes prior to IUD placement. The primary outcome was pain with IUD placement on a 10cm visual analog scale (VAS). Sample size was calculated to provide 80% power to show a 2.0cm difference (α=0.05) in the primary outcome. Secondary outcomes included pain with study drug injection, speculum insertion, tenaculum placement, uterine sounding, and at 5 and 15 minutes after IUD placement. Results A total of 67 women participated in the study, 33 in the ketorolac arm and 34 in the placebo arm. There were no differences in baseline demographics including age, BMI, and race. There were no differences in median pain scores for IUD placement in the placebo versus ketorolac groups (5.2cm vs 3.6cm, p=0.99). There was a decrease in median pain scores at 5 minutes (2.2cm vs 0.3cm, p=<0.001) and 15 minutes (1.6cm vs 0.1cm, p=<0.001) after IUD placement but no difference for all other time points. Nulliparous participants (n=16, 8 per arm) had a decrease in pain scores with IUD placement (8.1cm vs 5.4cm, p=0.02). In this study, 22% of participants in the placebo group and 18% in the ketorolac group reported injection pain was as painful as IUD placement. Conclusions Ketorolac does not reduce pain with IUD placement but does reduce pain at 5 and 15 minutes after placement.

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“…(2006)2019Nulliparous and parous400 mg ibuprofen versus placeboOverall pain measured on 0–10 VASNot significant (median score 1.0 in both treatment groups)2Chor et al . (2012)81Mainly parous (96%)800 mg ibuprofen versus placeboMeasured at different time points on 0–10 VASNot significant (mean score during actual insertion 3.69 versus 3.34, P = 0.91)2Karabayirli et al (2012)10350 mg tramadol versus 550 mg naproxen sodium versus placeboOverall pain measured on 0–10 VASSignificant reduction in mean pain score with tramadol versus naproxen sodium (2.31 versus 2.94, P = 0.003) and with naproxen sodium versus placebo (2.94 versus 4.88, P = 0.001) 2 Pre-insertion cervical primingSääv et al . (2007)80Nulliparous400 µg misoprostol (sublingual) versus placeboOverall pain measured on 0–10 VASNot significant (median score 7.0 versus 6.5, P = 0.20)2Heikinheimo et al .…”

Section: Pain Management Strategies: Critical Review Of the Evidence mentioning

confidence: 98%

“…Three RCTs have evaluated the prophylactic use of oral analgesia versus placebo for reducing pain associated with IUC insertion (Hubacher et al ., 2006; Chor et al ., 2012; Karabayirli et al ., 2012) (Table I). …”

Section: Pain Management Strategies: Critical Review Of the Evidence mentioning

confidence: 99%

Management of pain associated with the insertion of intrauterine contraceptives

Gemzell‐Danielsson

Mansour²,

Fiala

et al. 2013

Human Reproduction Update

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BACKGROUNDMost intrauterine contraception (IUC) placements do not require pain relief. However, small proportions of nulliparous (∼17%) and parous (∼11%) women experience substantial pain that needs to be proactively managed. This review critically evaluates the evidence for pain management strategies, formulates evidence-based recommendations and identifies data gaps and areas for further research.METHODSA PubMed literature search was undertaken. Relevant articles on management of pain associated with IUC insertion, published in English between 1980 and November 2012, were identified using the following search terms: ‘intrauterine contraception’, ‘insertion’ and ‘pain’. RCTs were included; further relevant articles were also identified and included as appropriate.RESULTSSeventeen studies were identified and included: 12 RCTs and one non-randomized study of pre-insertion oral analgesia, cervical priming and local anaesthesia; one systematic review and one RCT on post-insertion analgesia and two non-randomized studies on non-pharmacological interventions. There was no conclusive evidence that any prophylactic pharmacological intervention reduces pain associated with IUC insertion. However, most of the regimens studied were adopted from hysteroscopy or abortion and effectiveness in specific subsets of women has not been studied adequately. A systematic review found non-steroidal anti-inflammatory agents (NSAID) to be effective in reactively treating post-insertion pain, but no benefit was found with prophylactic use.CONCLUSIONSNo prophylactic pharmacological intervention has been adequately evaluated to support routine use for pain reduction during or after IUC insertion. Women's anxiety about the procedure may contribute to higher levels of perceived pain, which highlights the importance of counselling, and creating a trustworthy, unhurried and professional atmosphere in which the experience of the provider also has a major role; a situation frequently referred to as ‘verbal anaesthesia’.

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Comparison of the Analgesic Effects of Oral Tramadol and Naproxen Sodium on Pain Relief During IUD Insertion

Cited by 38 publications

References 13 publications

Intrauterine levobupivacaine for pain control during intrauterine device insertion

Intrauterine levobupivacaine for pain control during intrauterine device insertion

Ketorolac for Pain Control With Intrauterine Device Placement

Management of pain associated with the insertion of intrauterine contraceptives

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