Network Meta-Analysis of Randomized Controlled Trials Comparing Safety and Efficacy of Pharmacological Treatments in Reducing Pain During Intrauterine Device Insertion.

Conflicting evidence exists regarding the effectiveness of pharmacological interventions in reducing pain during intrauterine device (IUD) insertion. This study aimed to evaluate the safety and efficacy of various analgesics and to rank their effectiveness. A total of 71 randomized controlled trials (RCTs) involving 10,870 women were included. Data were sourced from PubMed, Cochrane Library, Scopus, and other databases up to September 2023. Analyses were performed using the Netmeta package in R, with results reported as standardized mean differences (SMDs) and risk ratios (RRs), each with corresponding 95% confidence intervals (CIs). Lidocaine 4% gel (5 mL) emerged as the most effective option for pain relief during IUD insertion (SMD = -4.5; 95% CI: -5.9- -3.0; low-quality evidence), followed by lidocaine 1% solution (10 mL; SMD = -3.20). Lidocaine 4% gel also ranked highest for reducing pain during tenaculum placement, while misoprostol 400 mcg improved the ease of IUD insertion. Despite the low quality of evidence, lidocaine 4% gel appears to be the most effective pharmacological intervention for pain reduction during IUD insertion.