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.

Subcutaneous wound closure using interrupted technique of suturing in obese patients is superior to continuous technique as regard wound complications. Clinical trials.gov ID Identifier (NCT 03354078).

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Objective: To evaluate the evidence about the safety and efficacy of tramadol in pain relief during diagnostic outpatient hysteroscopy (OH). Design: Systematic review and meta-analysis of randomized controlled trials. Setting: Not applicable. Patient(s): Patients undergoing diagnostic OH received tramadol versus those who were administered placebo. Intervention(s): Electronic databases were searched using the following MeSH terms (tramadol OR opioids OR opioid OR narcotic OR narcotics) AND (hysteroscopy OR hysteroscopic). Main Outcome Measure(s): Pain assessed by visual analogue scale (VAS) during OH, immediately and 30 minutes after the procedure. Result(s): One hundred thirteen studies were identified of which four randomized clinical trials were deemed eligible for this review (tramadol: n ¼ 209; placebo: n ¼ 209). The pooled estimate showed that tramadol significantly reduced VAS during procedure than placebo (weighted mean difference [WMD] ¼ À1.33; 95% confidence interval [CI] À1.78 to À0.88, I 2 ¼ 3%, P ¼ .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD ¼ À1.05; 95% CI À1.49 to À0.61, I 2 ¼ 0, P ¼ .84) and 30 minutes after (WMD ¼ À0.98; 95% CI À1.30 to À0.65, I 2 ¼ 0, P ¼ .88). Conclusion(s):This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH. (Fertil Steril Ò 2019;111:547-52. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

We found no statistically significant difference in the efficacy of cervical priming between oral misoprostol and vaginal misoprostol.

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