Oral Ketorolac for Pain Relief During Intrauterine Device Insertion: A Double-Blinded Randomized Controlled Trial

Crawford, Michelle; Davy, Susan; Book, Nicole M.; Elliott, John O.; Arora, Amol

doi:10.1016/j.jogc.2017.05.014

Cited by 11 publications

(22 citation statements)

References 19 publications

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“…Five RCTs evaluated the effectiveness of oral analgesia on the experience of pain with IUC placement and one RCT compared multiple analgesic agents . One RCT, reported a 15‐mm reduction in mean pain score with oral ketorolac (20 mg) given 40‐60 minutes before IUC placement when compared with placebo . Although statistically significant, the authors suggested that the time required for the maximum analgesic effect of ketorolac (1‐2 hours after administration) may have affected the outcome.…”

Section: Resultsmentioning

confidence: 99%

“…Although statistically significant, the authors suggested that the time required for the maximum analgesic effect of ketorolac (1‐2 hours after administration) may have affected the outcome. The effect of the intervention may have been more accurate, although less practical, if measured at a later time‐point . Four studies, evaluating 550 mg naproxen sodium, N 2 O/O 2 and ibuprofen compared with placebo, found no difference in mean pain scores at the time of IUC placement between the treatment and control groups; however, a reduction in median pain score was observed at 5 minutes (9 mm) and 15 minutes (11.2 mm) after IUC placement in the naproxen sodium group when compared with placebo …”

Section: Resultsmentioning

confidence: 99%

“…Although 12 RCTs were identified as being at low risk of bias within these categories, when looking at the potential for “other sources” of bias, all were seen as being at high risk due to a number of factors: they offered other analgesics besides the study drugs, recruited women who were looking for IUC placement and, in some cases, there was overlap in the VAS pain scores between treatment and placebo groups or the VAS pain scores in both groups were low (<4).…”

Section: Resultsmentioning

confidence: 99%

“…Our updated review set out to identify whether new RCTs contributed to further knowledge regarding effective pain strategies for IUC placement and identified 13 RCTs describing pharmacological interventions that result in lower pain scores when compared with placebo or control groups . The majority of these interventions involve pre‐insertion local anesthesia with lidocaine preparations.…”

Section: Discussionmentioning

confidence: 99%

“…Authors of nine of the RCTs reviewed here described the differences in pain scores between the intervention (oral ketorolac, vaginal misoprostol, lidocaine [spray, gel or paracervical block] and LP cream) and the placebo/control as being clinically relevant . The differences in pain scores within these studies ranged from 15 to 41 mm.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review

Gemzell‐Danielsson

Jensen

Monteiro

et al. 2019

Acta Obstet Gynecol Scand

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A 2013 review found no evidence to support the routine use of pain relief for intrauterine contraceptive (IUC) placement; however, fear of pain with placement continues to be a barrier to use for some women. This narrative review set out to identify (1) new evidence that may support routine use of pain management strategies for IUC placement; (2) procedure‐related approaches that may have a positive impact on the pain experience; and (3) factors that may help healthcare professionals identify women at increased risk of pain with IUC placement. A literature search of the PubMed and Cochrane library databases revealed 550 citations, from which we identified 43 new and pertinent studies for review. Thirteen randomized clinical trials, published since 2012, described reductions in placement‐related pain with administration of oral and local analgesia (oral ketorolac, local analgesia with different lidocaine formulations) and cervical priming when compared with placebo or controls. Four studies suggested that ultrasound guidance, balloon dilation, and a modified placement device may help to minimize the pain experienced with IUC placement. Eight publications suggested that previous cesarean delivery, timing of insertion relative to menstruation, dysmenorrhea, expected pain, baseline anxiety, and size of insertion tube may affect the pain experienced with IUC placement. Oral and local analgesia and cervical priming can be effective in minimizing IUC placement‐related pain when compared with placebo, but routine use remains subject for debate. Predictive factors may help healthcare professionals to identify women at risk of experiencing pain. Targeted use of effective strategies in these women may be a useful approach while research continues in this area.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review

Gemzell‐Danielsson

Jensen

Monteiro

et al. 2019

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

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Pharmacologic Approaches to Pain Management with IUD Insertion

Akers

2019

Optimizing IUD Delivery for Adolescents and Young Adults

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

Samy

Abbas

Mahmoud

et al. 2019

Fertility and Sterility

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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.

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Oral Ketorolac for Pain Relief During Intrauterine Device Insertion: A Double-Blinded Randomized Controlled Trial

Cited by 11 publications

References 19 publications

Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review

Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review

Pharmacologic Approaches to Pain Management with IUD Insertion

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

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