Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis

Samy, Ahmed; Abbas, Ahmed M.; Mahmoud, Mostafa; Taher, Ayman; Awad, Mohamed; Husseiny, Tarek El; Hussein, Mohamed; Ramadan, Mohamed; Shalaby, Mohamed; Sharkawy, Mohamed El; Hatem, Dina; Wali, Ahmed A.; Abd-El-Fatah, Shimaa Mostafa; Hussein, Amr H.; Haggag, Hisham

doi:10.1016/j.fertnstert.2018.11.012

Cited by 31 publications

(29 citation statements)

References 60 publications

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“…Also, in cases with retained placenta, it may have a role in the management of associated bleeding which mostly results from atony [14] [15]. In the field of gynecology, misoprostol could be used for induction of cervical ripening before office gynecological procedures [16] [17] [18]. This could decrease the associated pain induced by transcervical passage of instruments.…”

Section: Introductionmentioning

confidence: 99%

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Youssef¹,

Khalifa²,

Bahaa³

et al. 2019

OJOG

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Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS.

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Section: Introductionmentioning

confidence: 99%

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Youssef¹,

Khalifa²,

Bahaa³

et al. 2019

OJOG

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“…The optimal method of pain relief during IUD insertion remains undefined (12, 13). A contemporary systematic review and network meta-analysis of numerous lines of pharmacologic analgesic interventions—including placebo, nonsteroidal anti-inflammatory drugs, nitric oxide donors, lavender scent, lidocaine, and misoprostol—demonstrated no tangible effectiveness for IUD insertion-related pain (14). Conversely, lidocaine-prilocaine cream (genital mucosal application) was the most effective intervention for IUD insertion-related pain (14).…”

Section: Introductionmentioning

confidence: 99%

“…A contemporary systematic review and network meta-analysis of numerous lines of pharmacologic analgesic interventions—including placebo, nonsteroidal anti-inflammatory drugs, nitric oxide donors, lavender scent, lidocaine, and misoprostol—demonstrated no tangible effectiveness for IUD insertion-related pain (14). Conversely, lidocaine-prilocaine cream (genital mucosal application) was the most effective intervention for IUD insertion-related pain (14). However, when lidocaine-prilocaine was compared head-to-head with other pharmacologic interventions, including placebo, it did not exhibit significantly reduced pain 5-20 minutes after IUD insertion (14).…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, lidocaine-prilocaine cream (genital mucosal application) was the most effective intervention for IUD insertion-related pain (14). However, when lidocaine-prilocaine was compared head-to-head with other pharmacologic interventions, including placebo, it did not exhibit significantly reduced pain 5-20 minutes after IUD insertion (14). More research is warranted for alternative analgesics to control pain during IUD insertion procedure.…”

Section: Introductionmentioning

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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“…14,15 In the field of gynecology, misoprostol could be used for induction of cervical ripening before office gynecological procedures. [16][17][18] This could decrease the associated pain induced by transcervical passage of instruments.…”

Section: Introductionmentioning

confidence: 99%

Intrauterine Misoprostol versus intravenous Oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss: a randomised clinical trial

Abdelaleem

Abdelaleem²,

Abbas

2019

Int J Reprod Contracept Obstet Gynecol

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Background: The objective of the present study was to compare the efficacy of intrauterine misoprostol with intravenous oxytocin infusion in reducing blood loss during and after cesarean section (CS).Methods: An open, randomized, clinical trial, registered (ClinicalTrials.gov ID: NCT03148574) conducted between July 1, 2017 and April 1, 2018. The study included 240 pregnant females that were recruited at term (37-40 weeks) gestation scheduled for either elective or emergency CS. Eligible participants were randomly allocated into two equal groups: Group A: patients who receive intravenous infusion of 10 I.U diluted to 500ml of normal saline for 30 minute after delivery. Group B: patients received 400μg misoprostol intrauterine just after cord clamping and delivery of the placenta. Primary outcome measure was assessment of amount of intraoperative and postoperative blood loss.Results: The intraoperative and 2h postoperative blood loss in the misoprostol group was higher than oxytocin group (p<0.001). Hemoglobin level decreased significantly among both groups, manifested by the highly significant p value in comparison of pre and postoperative Hb level in the two groups (p<0.001). However, the blood loss in the misoprostol group was higher than oxytocin group (p=0.004). There was a statistical significant differences between both groups as regards the need for additional uterotonic drug (66% in misoprostol group vs 5% in oxytocin group, P<0.001). Shivering and pyrexia were more in common in the misoprostol group while vomiting, headache and giddiness were significantly higher among oxytocin group.Conclusions: Administration of misoprostol 400mcg through intrauterine route appears to be less effective than intravenous oxytocin infusion in reducing blood loss during and after CS.

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Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis

Cited by 31 publications

References 60 publications

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

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

Intrauterine Misoprostol versus intravenous Oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss: a randomised clinical trial

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