Use of Local Anesthetic Agents and Conscious Sedation in Intrauterine Device Insertion: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
2.2. Literature Search Strategy
2.3. Screening and Study Selection
2.4. Critical Appraisal
Bias Assessment
3. Results
4. Discussion
4.1. Pain Reduction with Conscious Sedation
4.2. Pain Reduction with Local Anesthetics
4.3. The Effect of NSAIDs on IUD Insertion
4.4. Association Between Reproductive Factors and Elevated Pain in IUD Insertion
5. Limitations
6. Conclusions
7. Suggestions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Authors | Year of Publication | Country | Title | Sample Size | Age | Study Design |
---|---|---|---|---|---|---|
Cirik et al. [19] | 2013 | Turkey | Paracervical block with 1% lidocaine for pain control during intrauterine device insertion: a prospective, single-blinded, controlled study | 95 | 18–45 | RCT |
Mohammed et al. [20] | 2020 | Egypt | Vaginal or sublingual misoprostol before insertion of an intrauterine device in women who have previously had a cesarean section | 200 | 18–45 | RCT |
Saad et al. [21] | 2022 | Egypt | Role of vaginal misoprostol before intrauterine device insertion | 80 | >18 | RCT |
Salama et al. [54] | 2022 | Egypt | Role of vaginal misoprostol prior to levonorgestrel-releasing IUD insertion | 113 | 25–45 | RCT |
Hajiesmaello et al. [22] | 2019 | Iran | Evaluation of the effect of 10% lidocaine spray on reducing the pain of intrauterine device insertion: A randomized controlled trial | 80 | 18–45 | RCT |
Hassan et al. [23] | 2023 | Egypt | Efficacy and safety of Vaginal Misoprostol in reducing pain during Levonorgestrel Intrauterine Device insertion. | 130 | 20–45 | RCT |
Abbas et al. [24] | 2018 | Egypt | Does lidocaine gel produce an effective analgesia prior to copper IUD insertion? Randomized clinical trial | 100 | 18–50 | RCT |
El-Sayed et al. [25] | 2021 | Egypt | Using of Misoprostol Vaginally Prior To Intrauterine Contraceptive Device Insertion Following Previous Insertion Failure: Randomized Clinical Trial | 100 | 20–35 | RCT |
Bayoumy et al. [26] | 2018 | Egypt | Lidocaine for Pain Control during Intrauterine Contraceptive Device Insertion: A Randomized Clinical Trial | 123 | >18 | RCT |
Sakna et al. [27] | 2021 | Egypt | Vaginal Misoprostol Prior to Intrauterine Contraceptive Device Insertion in Women Who Delivered Only by Elective Caesarean Section: Randomized Clinical Trial | 210 | 20–40 | RCT |
Elsafty, et al. [28] | 2015 | Egypt | Does lidocaine 10% spray reduce pain during intrauterine contraceptive device insertion? a pilot randomized controlled clinical trial | 200 | 18–45 | RCT |
de Oliveira et al. [29] | 2021 | Brazil | Use of naproxen versus intracervical block for pain control during the 52 mg levonorgestrel-releasing intrauterine system insertion in young women: a multivariate analysis of a randomized controlled trial. | 100 | 15–24 | RCT |
Panichyawat et al. [30] | 2020 | Thailand | 10% lidocaine spray for pain control during intrauterine device insertion: a randomized, double-blind, placebo-controlled trial. | 124 | 18–45 | RCT |
Ashour et al. [38] | 2020 | Egypt | Comparative efficacy of vaginal misoprostol vs. vaginal dinoprostone administered 3 hours prior to copper T380A intrauterine device insertion in nulliparous women: a randomized controlled trial. | 129 | 18–25 | RCT |
Conti, et al. [39] | 2019 | USA | Self-administered vaginal lidocaine gel for pain management with intrauterine device insertion: a blinded, randomized controlled trial. | 215 | ≥18 | RCT |
Mody et al. [31] | 2018 | USA | Paracervical block for intrauterine device placement among nulliparous women: a randomized controlled trial. | 64 | 18–45 | RCT |
Karasu et al. [32] | 2017 | Japan | Lidocaine for pain control during intrauterine device insertion | 200 | >18 | RCT |
Abdellah et al. [33] | 2017 | Egypt | Vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section: a randomized double-blind clinical trial. | 140 | 18–45 | RCT |
Abbas et al. [34] | 2017 | Egypt | Effect of cervical lidocaine–prilocaine cream on pain perception during copper T380A intrauterine device insertion among parous women: A randomized double-blind controlled trial. | 120 | 18–49 | RCT |
Singh et al. [13] | 2016 | USA | A randomized controlled trial of nitrous oxide for intrauterine device insertion in nulliparous women. | 80 | 13–45 | RCT |
Aksoy et al. [35] | 2016 | Turkey | Lidocaine 10% spray to the cervix reduces pain during intrauterine device insertion: a double-blind randomized controlled trial. | 200 | ≥18 | RCT |
Tornblom- Paulander et al. [36] | 2015 | Sweden | Novel topical formulation of lidocaine provides significant pain relief for intrauterine device insertion: pharmacokinetic evaluation and randomized placebo-controlled trial. | 218 | ≥18 | RCT |
Tavakolian et al. [37] | 2015 | Iran | Lidocaine–prilocaine cream as analgesia for IUD insertion: a prospective, randomized, controlled, triple blinded study. | 92 | ≥18 | RCT |
Allen et al. [40] | 2013 | USA | Higher dose cervical 2% lidocaine gel for IUD insertion: a randomized controlled trial. | 145 | 18–49 | RCT |
Scavuzzi et al. [41] | 2013 | Brazil | Misoprostol prior to inserting an intrauterine device in nulligravidas: a randomized clinical trial. | 179 | ≥18 | RCT |
McNicholas et al. [42] | 2012 | USA | Cervical lidocaine for IUD insertional pain: a randomized controlled trial. | 199 | 18–45 | RCT |
Maguire et al. [43] | 2012 | USA | Intracervical lidocaine gel for intrauterine device insertion: a randomized controlled trial | 200 | 18–45 | RCT |
Charandabi et al. [44] | 2010 | Iran | Effect of lidocaine gel on pain from copper IUD insertion: A randomized double-blind controlled trial | 96 | 18–45 | RCT |
Dogan et al. [45] | 2017 | Turkey | Paracervical block and paracetamol for pain reduction during IUD insertion: a randomized controlled study | 118 | ≥18 | RCT |
Envall et al. [46] | 2019 | Sweden | Intrauterine mepivacaine instillation for pain relief during intrauterine device insertion in nulliparous women: a double-blind, randomized, controlled trial | 86 | ≥18 | RCT |
Castro et al. [47] | 2014 | Brazil | Effect of intracervical anesthesia on pain associated with the insertion of the levonorgestrel-releasing intrauterine system in women without previous vaginal delivery: a RCT | 98 | 18–45 | RCT |
De Nadai et al. [48] | 2019 | Brazil | Intracervical block for levonorgestrel-releasing intrauterine system placement among nulligravid women: a randomized double-blind controlled trial | 302 | ≥18 | Randomized, double-blind, parallel, controlled trial |
Hashem et al. [49] | 2022 | Egypt | 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 | 210 | ≥18 | RCT |
EL-Gharib et al. [50], | 2019 | Egypt | Effect of diclofenac versus misoprostol on pain perception during copper IUD insertion in cases of stenosed cervix | 60 | 18–40 | RCT |
El-Ghannam et al. [51] | 2023 | Egypt | Vaginal misoprostol versus Dinoprostone before copper IUD application in women with anticipated difficult loop application | 100 | ≥18 | RCT |
Sakna et al. [55] | 2023 | Egypt | Lidocaine spray 10% versus oral ibuprofen tablets in pain control during copper intrauterine device insertion (a randomized controlled trial) | 140 | ≥18 | prospective, randomized clinical study |
Fahmy et al. [52] | 2015 | Egypt | Comparison of 1% lidocaine paracervical block and NSAIDs in reducing pain during intrauterine device insertion | 150 | ≥18 | RCT |
Nugud, et al. [53] | 2021 | Egypt | Effect of diclofenac versus misoprostol on pain perception during intrauterine contraceptive device insertion | 64 | ≥18 | Randomized double- blind controlled trial. |
Samy et al. [16] | 2019 | Egypt | Benefits of vaginal Dinoprostone administration prior to levonorgestrel-releasing intrauterine system insertion in women delivered only by elective cesarean section: a randomized double-blinded clinical trial. | 200 | ≥18 | RCT |
Authors | Intervention | Comparison | Main Outcomes |
---|---|---|---|
Cirik [19] | 10 mL 1% lidocaine for paracervical block | A group received 10 mm 0.9% NaCl solution as placebo and another group received no analgesia | Pain scores during IUD insertion in paracervical block group compared to placebo and no treatment groups |
Mohammed [20] | 400 μg misoprostol tablets vaginally | 400 μg misoprostol sublingually | The proportion of failed IUD insertions defined as an unsuccessful insertion, regardless of the reason |
Saad [21] | 400 μg misoprostol vaginally | Placebo group with two tablets of folic acid | Effect of misoprostol on cervical ripening and successful IUD insertion |
Salama [54] | 200 mcg or 400 mcg misoprostol vaginally | Placebo vaginal tablet | Difficulty of Mirena IUD insertion and pain score assessment between the three groups |
Hajiesmaello [22] | Four puffs of 10% lidocaine spray, with each containing 10 mg lidocaine | Routine IUD insertion with no analgesia | Pain score before, during and after IUD insertion process |
Hassan [23] | 400 μg misoprostol vaginally | Placebo control group with contraceptive tablets | Level of discomfort after IUD insertion following vaginal misoprostol or placebo |
Abbas [24] | Lidocaine gel | Placebo (an inert gel) | Difference in mean pain VAS scores during IUD insertion. |
El-Sayed [25] | 200 mg misoprostol vaginally | Placebo | To investigate the possible effect of vaginal administration of misoprostol to insertion of IUCDs in women with previous IUCD insertion failure. |
Bayoumy et al. [26] | Different local lidocaine preparations (spray, cream, injection) | No comparison group | Pain scores assessed by 10-point VAS scale at three different points; baseline after application of speculum and analgesic administration, after grasping cervix with tenaculum, then following hysterometry and IUCD insertion. |
Sakna et al. [27] | Vaginal misoprostol 400 μg | Placebo | Proportion of failed IUCD insertions and degree of difficulty of the IUCD insertion |
Elsafty, et al. [28] | 10% lidocaine spray | Placebo | Pain assessment during different stages of IUD insertion |
de Oliveira et al. [29] | 550 mg Naproxen Sodium for pain control during 52 mg LNG-IUS insertion | 2% lidocaine intracervical block | Pain assessment during different stages of IUD insertion |
Panichyawat et al. [30] | 10% lidocaine spray | Placebo | VAS score immediately after Cu-IUD placement |
Ashour et al. [38] | Vaginal misoprostol | Vaginal Dinoprostone | Pain assessment during different stages of IUD insertion |
Conti et al. [39] | 2% lidocaine gel | Placebo | Pain assessment during different stages of IUD insertion, procedure time, ease of insertion |
Mody et al. [31] | 1% lidocaine paracervical block | No block | Pain assessment during different stages of IUD insertion |
Karasu et al. [32] | Topical lidocaine spray, cream, and injection | No comparison group | Pain assessment during different stages of IUD insertion |
Abdellah et al. [33] | Vaginal misoprostol | Placebo | Ease of IUD insertion, number of successful insertions, pain intensity scores, satisfaction, need for analgesics |
Abbas et al. [34] | Lidocaine–prilocaine cream | Placebo | Pain assessment during different stages of IUD insertion |
Singh et al. [13] | Nitrous oxide | Oxygen | Pain assessment during different stages of IUD insertion |
Aksoy et al. [35] | 10% lidocaine spray | Placebo | IUD insertion pain score, as measured by the 10 cm VAS. |
Tornblom-Paulander et al. [36] | Lidocaine formulation | Placebo | To investigate the pharma- cokinetics, efficacy, and safety of this formulation of lidocaine as an anesthetic for IUD insertion. |
Tavakolian et al. [37] | Local anesthetic that contains 25 mg lidocaine and 25 mg of prilocaine per gram. | Placebo | To determine the effect of the used anesthetic on IUD insertion pain. |
Allen et al. [40] | 2% lidocaine gel | Placebo | Pain during IUD insertion on a 0 to 100 mm visual analog scale. |
Scavuzzi et al. [41] | Vaginal misoprostol | Placebo | Effectiveness of vaginal misoprostol in dilating the cervix prior to IUD insertion in nulligravidas. |
McNicholas et al. [42] | Intracervical 2% lidocaine gel | Placebo | To evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. |
Maguire et al. [43] | 2% lidocaine gel | Placebo | Effect of intracervical 2% lidocaine gel prior to IUD insertion on pain during sounding and IUD insertion as measured by the 100 mm VAS |
Charandabi et al. [44] | 2% lidocaine gel | Lubricant gel or no intervention | Effect of lidocaine gel on pain from copper IUD insertion. |
Dogan et al. [45] | Paracervical block and Oral Paracetamol (500 mg) | No intervention. | Pain levels using VAS during and after insertion of IUD. |
Envall et al. [46] | Mepivacaine 1% | Placebo | Difference in VAS score between intervention and placebo at the time of IUD insertion |
Castro et al. [47] | NSAID (ibuprofen, 400 mg) | Injectable local anesthetic (2% lidocaine without vasoconstrictor) | Effect of intracervical anesthesia compared with NSAIDs on pain scores following LNG-IUS insertion in women without a previous vaginal delivery who had not previously used any IUCD |
De Nadai et al. [48] | Intracervical block (3.6 mL 2% lidocaine (72 mg) | Placebo | Pain measurement immediately after LNG-IUS insertion. |
Hashem et al. [49] | 5 mL of 5% lidocaine–prilocaine cream | Placebo | The difference in pain scores during IUD insertion |
EL-Gharib et al. [50] | Vaginal misoprostol | IM diclofenac sodium 75 mg | Assessment of the analgesic effect of vaginal misoprostol versus intramuscular diclofenac sodium and in facilitating IUCD insertion in women with cervical stenosis. |
El-Ghannam et al. [51] | Vaginal misoprostol | 3 mg dinoprostone | The measured the success rate of IUD insertion of both groups. |
Sakna et al. [55] | 10% local lidocaine spray, Ibuprofen | Ibuprofen | Self-reported pain score |
Fahmy et al. [52] | 1% lidocaine paracervical block | Naproxen | Pain on speculum placement, tenaculum placement, intrauterine device insertion, and after procedure |
Nugud et al. [53] | (400 mcg) of misoprostol | Placebo | Effect of vaginal misoprostol and intramuscular diclofenac sodium in decreasing pain and facilitating IUCD insertion. |
Samy et al. [16] | Vaginal dinoprostone 3 mg | Vaginal placebo | the mean difference in pain scores during LNG-IUD insertion between both groups. |
Authors | Success Rate | Ease of Insertion | Pain Scores | Side Effect |
---|---|---|---|---|
Cirik [19] | NA | NA | This study demonstrated significantly lower pain perception in the paracervical block group when compared to the placebo and no treatment groups. | There were 5 patients who had vasovagal syncope, one in the paracervical group, 2 in saline group and 2 were in the no treatment group (p = 0.36). No bleeding or uterine perforation reported |
Mohammed [20] | There was no statistically significant difference between the vaginal misoprostol group and sublingual misoprostol group regarding the success rate from first and second attempts. | NA | There is a highly statistically significant increase in pain during IUD applications in sublingual misoprostol group than vaginal misoprostol group (p = 0.001). | No significant difference in postinsertion US follow-up, infection, or changes in postinsertion menstruation between the two groups. |
Saad [21] | Misoprostol group: 70% success vs. Placebo group: 25% success (p < 0.001) | Vaginal administration of 400 μg misoprostol 3 h before IUD insertion was significantly associated with less difficulty of insertion | Using misoprostol before IUD insertion decreases pain during uterine sounding significantly | Vaginal misoprostol (400 μg) had significantly reduced complications of IUD insertion such as pain and bleeding. |
Salama [54] | NA | Mirena insertion significantly easier in Misoprostol groups compared to placebo | Pain score during Mirena IUD insertion in group 2 and group 3 (misoprostol groups) is significantly lower than in group 1 (placebo group) (p = 0.031 and 0.035, respectively). | Nausea and/or vomiting, uterine cramps significantly more frequent with misoprostol 400 mcg compared to placebo and misoprostol 200 mcg. Diarrhea was presented only in misoprostol groups, Making a significant difference when compared with placebo. No significant differences in fever or perforation |
Hajiesmaello [22] | All participants had successful IUD insertions. | NA | Significant reduction in pain scores during hysterometer and during the IUD insertion (p < 0.001). There was also a significant difference in pain score at 15 min after IUD insertion between the control and intervention groups | No systemic adverse effects were observed |
Hassan [23] | 4 failed insertions and 126 were successful (96.9 success rate) | IUD insertion is significantly easier in Misoprostol groups compared to the placebo (p < 0.001) | There were no statistically significant terms of anticipated pain speculum, pain after 20 min, and insertion time p-value > 0.05. | There was no statistically significant spotting, abdominal cramps, nausea, vomiting, shivering, fever, and need additional analgesia p-value > 0.05. On the other hand, there was a statistical difference in diarrhea < 0.001. |
Abbas [24] | All participants had successful IUD insertion | There was no statistical significant differences between both groups (lidocaine gel group and placebo group) in regard to the ease of insertion. | Lower pain scores during vulsellum placement and uterine sounding in lidocaine group (p < 0.001). No statistical significant differences between both groups in other steps of IUD insertion. | No cases of uterine perforation or vasovagal reactions were observed in both groups |
El-Sayed [25] | Misoprostol increased the success rate from 60.6% to 91.4% in the group with previous cesarean section, and from 29.4% to 80% in the group with previous vaginal delivery with a p value 0.037. | NA | NA | NA |
Bayoumy et al. [26] | All procedures were successful (100%) | NA | Pain score after grasping of cervix with tenaculum and pain score after hysterometry and IUCD insertion by VAS signify that lidocaine spray 10% decreases pain felt during the process of IUCD insertion | No flushing or metallic taste adverse effects were observed in any of the 3 study groups. whereas n = 3 (7.3%) participants reported redness of skin with lidocaine spray and n = 5 (12.2%) participants with lidocaine cream. |
Sakna et al. [27] | Administration of misoprostol prior to IUCD insertion was significantly associated with an almost 2-fold increase in the success rate of IUCD insertion. | Insertion was significantly easier among the Misoprostol group (p < 0.001) | Pain perception was significantly lower among Misoprostol group than among control group. | Nausea, vomiting, and shivering significantly more frequent in Misoprostol group compared to control |
Elsafty et al. [28] | NA | NA | The lidocaine group had significantly lower pain scores during cervical grasping and traction than the placebo (saline) group (p < 0.001) | Severe burning sensation in 2 participants in lidocaine group; Vasovagal syncope in 1 participant in saline group; Excluded from the study |
de Oliveira et al. [29] | Women in the intracervical group presented high proportion of malpositioned IUS on transvaginal US compared to naproxen group. (11.8% vs. 0%, respectively; p < 0.05) | The difficulty of insertion was statistically similar between the two groups | Lower pain perception in intracervical block using 2% lidocaine compared to naproxen group (p < 0.001) | Vasovagal-like responses (dizziness, nausea, vomiting) observed during LNG-IUS insertion; 3 in naproxen group versus 4 in the intracervical group |
Panichyawat et al. [30] | NA | NA | The 10% lidocaine spray group had significantly lower VAS score compared to placebo during and immediately after IUD insertion | Significantly more women in the 10% lidocaine group reported vaginal irritation side effect than women in placebo group (34 versus 1, respectively; p < 0.001) |
Ashour et al. [38] | NA | Significantly easier IUD insertion with misoprostol and dinoprostone groups compared to the placebo (p = 0.001 and p < 0.001, respectively) | Misoprostol and Dinoprostone groups had significantly lower pain scores during copper IUD insertion than placebo group (p = 0.02 and p < 0.001, respectively) | Side effects did not differ among the three groups |
Conti, et al. [39] | NA | NA | Only median pain scores at speculum insertion were significantly different between the lidocaine and placebo group (7 mm vs. 11 mm, respectively; p = 0.046) | NA |
Mody et al. [31] | NA | NA | Women who received the paracervical block reported less pain with IUD placement compared to women who received no block (median VAS score of 33 mm compared with 54 mm, p = 0.002). | There was no difference in patient reported adverse effects between the two groups |
Karasu et al. [32] | NA | NA | Pain related to IUD insertion was lower in the lidocaine spray and injection groups (p < 0.001). | NA |
Abdellah et al. [33] | Higher number of successful IUD insertions in the misoprostol group than the placebo group (69 [98.6%] vs. 61 [87.1%], p = 0.009). | The ease of insertion score was lower in the misoprostol group (2.2 ± 0.5 vs. 4.2 ± 0.5, p = 0.0001). | Lower pain score in the misoprostol group compared to the placebo group (2.7 ± 0.6 vs. 4.3 ± 0.8, p = 0.001) | Abdominal cramping and shivering occurred more in misoprostol group (22.9% vs. 4.3% and 14.3% vs. 2.9%, respectively), with no difference between both groups in other side effects. |
Abbas et al. [34] | NA | A lower ease of insertion score among lidocaine–prilocaine cream group compared to placebo group (p = 0.001). | Lower pain perception in the lidocaine–prilocaine cream group | NA |
Singh et al. [13] | NA | NA | Nitrous oxide did not significantly reduce pain | Adverse effects in N2O/O2 and O2 groups; dizziness, nausea, headache, vomiting reported; no significant difference between groups (p = 0.32) |
Aksoy et al. [35] | All procedures were successfully completed without severe complications or serious adverse reactions. | NA | A significantly lower score for overall pain during the procedure was found in the treatment group compared to controls (p < 0.001). | Successful procedures without severe complications; mild complications with vasovagal reactions (nausea, vomiting, dizziness); no systemic side effects with 10% lidocaine spray |
Tornblom-Paulander et al. [36] | NA | NA | Pain scores on the VAS were low, with mean values of <9 mm at all time points after IUD insertion. | Adverse events were similar in the placebo and lidocaine groups. No serious adverse events were reported. At least one adverse event occurred for 32 women who received the lidocaine (29.1%), and for 36 (33.3%) of those who received the placebo. The most common adverse events were nausea and gastrointestinal problems. |
Tavakolian et al. [37] | NA | NA | There was a significant difference between the two groups in the third stage (inserting IUD and removing the insertion tube) as it was 4.61 ± 2.55 in the placebo group and 2.65 ± 2.53 in the intervention group (p < 0.001). | NA |
Allen et al. [40] | NA | There was no difference between the groups in procedure difficulty as rated by the provider. | no difference in pain scores between the lidocaine and placebo groups. | No participants reported systemic lidocaine side effects. |
Scavuzzi et al. [41] | NA | Less difficulty in IUD insertion when misoprostol was used prior to insertion. | 44% reduction in moderate-to-severe pain during IUD insertion compared with the placebo group. | No significant differences in complications during IUD insertion; similar frequency of bleeding, vasovagal reaction, cramps, nausea, vomiting, and insertion failures; no uterine perforation reported. |
McNicholas et al. [42] | NA | NA | No significant difference in pain between groups. | Adverse events considered: 5 total expulsions (4 in placebo arm, 1 in lidocaine arm); 1 perforation in parous postpartum participant; 1 case of pelvic inflammatory disease. |
Maguire et al. [43] | One hundred ninety-seven women had successful IUD insertions. One IUD was not inserted due to suspicion of perforation during uterine sounding, and two were not inserted due to inappropriate IUD insertion into the cervical canal. | NA | No significant difference in pain between groups. | Side effects including nausea, vomiting, and dizziness highly similar between groups |
Charandabi et al. [44] | NA | NA | No significant difference in pain between groups. | NA |
Dogan et al. [45] | All patients had successful IUD insertion at first attempt. | All patients had successful IUD insertion at first attempt. | Lower pain perception | Procedural complications such as vasovagal symptoms and syncope, bleeding, immediate expulsion or mispositioning and uterine perforation did not occur. |
Envall et al. [46] | NA | NA | Lower pain perception | NA |
Castro et al. [47] | NA | Majority of the insertions were easy in both groups. | No significant difference in pain between groups | NA |
De Nadai et al. [48] | 99.3% success rate in the insertion of the levonorgestrel-releasing intrauterine system among nulligravid women (300 out of 302). | Similar among all groups | Significant pain reduction during and after the insertion of the LNG-IUS compared to the placebo, no-intervention groups. | NA |
Hashem et al. [49] | NA | Similar among all groups | Pain scores were significantly lower in the LP group compared to the placebo group. | Comparable drug-side effects between groups; Vomiting and abdominal cramps higher in misoprostol group (p = 0.039 and p = 0.093, respectively) |
EL-Gharib et al. [50] | NA | Misoprostol facilitated IUD insertion | Insignificant differences between misoprostol and diclofenac groups as regards pain score | Side effects of IUD insertion: Misoprostol group—nausea and vomiting (36.7%), syncopal attack (3.3%), bleeding (0%), perforation (0%), gastritis (0%); Diclofenac group—nausea and vomiting (0%), syncopal attack (0%), bleeding (0%), perforation (0%), gastritis (20%) |
El-Ghannam et al. [51] | 92% in the misoprostol group and 86% in the dinoprostone group. | Both misoprostol and dinoprostone were effective in easing the insertion of copper IUDs. | No significance difference between the two studied groups during IUD insertion | More side effects in group A (Misoprostol) than group B (Dinoprostone); no significant difference in side effects (p > 0.05) |
Sakna et al. [55] | 97.1% in the lidocaine spray group and 95.7% in the ibuprofen tablet group. The failure of insertion was statistically non-significant between the two groups. | Similar among all groups | Patients’ pain perception statistically was significantly lower among lidocaine spray group | NA |
Fahmy et al. [52] | NA | NA | No significance difference between two studied group during IUD insertion | Complications in two participants: small vaginal hematoma resolved with paracervical block; dyspepsia, heartburn, headache, and vaginal spotting with NSAIDs; no significant difference (p > 0.05) |
Nugud et al. [53] | NA | Misoprostol facilitated IUD insertion | No significance difference between two studied group during IUD insertion | Side effects in IUD insertion: nausea and vomiting in 37.5% and syncopal attack in 6.3% among the misoprostol |
Samy et al. [16] | NA | Dinoprostone facilitated IUD insertion | Pain scores were significantly lower in dinoprostone group compared to placebo group. | Side effects were not significantly different in Dinoprostone group versus placebo group |
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Altamimi, R.; Bin Salamah, R.; Almajed, E.; AlZabin, A.; Alzelfawi, L.; AlMutiri, W.; Alkinani, A.; Almusharaf, L. Use of Local Anesthetic Agents and Conscious Sedation in Intrauterine Device Insertion: A Systematic Review. Women 2025, 5, 2. https://doi.org/10.3390/women5010002
Altamimi R, Bin Salamah R, Almajed E, AlZabin A, Alzelfawi L, AlMutiri W, Alkinani A, Almusharaf L. Use of Local Anesthetic Agents and Conscious Sedation in Intrauterine Device Insertion: A Systematic Review. Women. 2025; 5(1):2. https://doi.org/10.3390/women5010002
Chicago/Turabian StyleAltamimi, Reem, Rawan Bin Salamah, Ebtesam Almajed, Alya AlZabin, Lama Alzelfawi, Wijdan AlMutiri, Amer Alkinani, and Lamya Almusharaf. 2025. "Use of Local Anesthetic Agents and Conscious Sedation in Intrauterine Device Insertion: A Systematic Review" Women 5, no. 1: 2. https://doi.org/10.3390/women5010002
APA StyleAltamimi, R., Bin Salamah, R., Almajed, E., AlZabin, A., Alzelfawi, L., AlMutiri, W., Alkinani, A., & Almusharaf, L. (2025). Use of Local Anesthetic Agents and Conscious Sedation in Intrauterine Device Insertion: A Systematic Review. Women, 5(1), 2. https://doi.org/10.3390/women5010002