Effect of self-administered vaginal dinoprostone on pain perception during copper intrauterine device insertion in parous women: a randomized controlled trial

Ashour, Ahmed; Nabil, Hala; Yosif, Mohamed F.; Hussein, Mohamed; Allah, Ahmed Abd; Mahmoud, Mostafa; Abdou, Hossam; Kholaif, Khaled; Kotb, Magd A.; Sharkawy, Mohamed El; Abdelhakim, Ahmed Mohamed; Ali, Ahmed Said; Nassar, Salma Ashraf; Abbassy, Amr; Ghamry, Nevein Kamal; Abdellatif, Ali A; Taher, Ayman; Mahy, Mohamed El

doi:10.1016/j.fertnstert.2020.05.004

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…36,37 A similar scenario is reported with their utilization prior to IUD insertion. Numerous studies agreed with our findings and reported reduced pain scores and easier insertions with misoprostol or dinoprostone utilization compared to placebo, [10][11][12][13]38,39 while other studies recommended against their routine utilization due to lack of efficacy and frequent side effects. 14,[40][41][42][43][44] Helmy et al 45 evaluated the efficacy of different doses of vaginal misoprostol prior to IUD insertion among women with a nulliparous cervix.…”

Section: Discussionsupporting

confidence: 89%

Comparative efficacy of lidocaine–prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: A randomized controlled trial

Hashem

Mahmoud

Islam

et al. 2022

Intl J Gynecology & Obste

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ObjectiveTo compare efficacy of lidocaine–prilocaine (LP) cream versus misoprostol versus placebo before levonorgestrel‐releasing intrauterine device (LNG‐IUD) insertion.MethodsThis randomized controlled trial (RCT) was conducted in a tertiary referral hospital from April 30, 2020 to March 1, 2021 on 210 parous women willing to receive LNG‐IUD and delivered only by elective cesarean delivery (CD). Participants received 200 μg vaginal misoprostol or 5 ml of LP cream 5% or placebo 3 h before LNG‐IUS insertion. Primary outcome was pain during LNG‐IUD insertion, while secondary outcomes were pain 10 min post‐procedure, ease of insertion, patient satisfaction, insertion time, and drug side effects.ResultsPain during LNG‐IUS insertion was reduced in LP group and misoprostol group compared to placebo group (2.1 ± 1.0 vs 3.7 ± 1.6; p <0.001) and (2.3 ± 1.3 vs 3.7 ± 1.6; p <0.001), respectively. Ease of procedure and patient satisfaction were significantly higher in LP and misoprostol groups than placebo (P <0.001). Need for additional analgesia was significantly higher in placebo group than in the other two groups (P = 0.009). Adverse events were not significantly different between the three groups except vomiting and abdominal cramps, which were higher with misoprostol.ConclusionLP cream and 200 μg of vaginal misoprostol administration before LNG‐IUD insertion in women delivered only by elective CD effectively reduced pain during insertion and 10 min post‐procedure with easier insertions, high patient satisfaction, and tolerable side effects. Pain reduction with LP cream was clinically significant.

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Section: Discussionsupporting

confidence: 89%

Comparative efficacy of lidocaine–prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: A randomized controlled trial

Hashem

Mahmoud

Islam

et al. 2022

Intl J Gynecology & Obste

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“…In two studies, the drugs (vaginal dinoprostone and placebo) were self-administered by patients. Although measures had been taken by investigators to remind patients about the time to vaginally self-administer the drugs three (19) and 12 (13) hours before the procedure, however, this cannot be certainly established, and we judged the other bias domain as high risk. The graph and summary of risk of bias are depicted in Supplemental Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were meta-analyzed (12, 13, 19, 21). The overall effect estimate did not exhibit statistically significant difference between both groups with regard to pain after IUD insertion (SMD=−0.57 [−1.19, 0.05], p=0.07).…”

Section: Resultsmentioning

confidence: 99%

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Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion: a systematic review and meta-analysis of randomized controlled trials

Abu‐Zaid

Alshahrani

Albezrah

et al. 2020

Preprint

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Objective: To investigate the safety and efficacy of vaginal dinoprostone versus placebo in pain relief during intrauterine device (IUD) insertion. Design: Systematic review and meta-analysis of randomized placebo-controlled trials. Setting: Not applicable. Patient(s): Women undergoing IUD insertion and receiving vaginal dinoprostone or placebo. Intervention(s): PubMed, Scopus, Web of Science, and Cochrane Library were screened from inception to 01-October-2020, using the following search strategy: (dinoprostone OR cervidil OR prepidil) AND (intrauterine device OR iud). Main outcome measure(s): IUD insertion related pain, patient satisfaction, provider ease of IUD insertion, and side effects. Result(s): Five studies met the study inclusion criteria, comprising 862 patients; equally 431 patients received vaginal dinoprostone and placebo. All studies had an overall low risk of bias. When compared to placebo, dinoprostone significantly correlated with decreased pain at tenaculum placement (SMD=-0.79, 95% CI [-1.43, -0.16], p=0.01), decreased pain at uterine sounding (SMD=-0.88, 95% CI [-1.54, -0.22], p=0.009), decreased pain at IUD insertion (SMD=-1.18, 95% CI [-1.74, -0.61], p<0.001), decreased need for additional analgesia (RR=0.34, 95% CI [0.22, 0.53], p<0.001), increased patient satisfaction (SMD=1.41, 95% CI [0.62, 2.20], p<0.001), and increased provider ease of IUD insertion (SMD=-1.17, 95% CI [-1.62, -0.73], p<0.001). Fever was statistically significantly higher in dinoprostone versus placebo group (RR=3.73, 95% CI [1.47, 9.44], p=0.006). All other side effects-including nausea, vomiting, shivering, diarrhea, abdominal cramps, vasovagal attack, uterine perforation, and postprocedural bleeding-did not substantially differ between both groups. Conclusions: This first ever meta-analysis advocates that dinoprostone is safe, effective, and yields favorable analgesic outcomes during IUD insertion.

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Which medication and when should it be administered for reducing pain in intrauterine device insertion?

Blumenfeld

2020

Fertility and Sterility

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Effect of self-administered vaginal dinoprostone on pain perception during copper intrauterine device insertion in parous women: a randomized controlled trial

Cited by 4 publications

References 26 publications

Comparative efficacy of lidocaine–prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: A randomized controlled trial

Comparative efficacy of lidocaine–prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: A randomized controlled trial

Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion: a systematic review and meta-analysis of randomized controlled trials

Which medication and when should it be administered for reducing pain in intrauterine device insertion?

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