Efficacy and Safety of Lidocaine Compared to Other Agents for Intrauterine Device Insertion Pain: A Systematic Review and Meta-Analysis.

BACKGROUND

Pain during intrauterine device (IUD) insertion remains a common barrier to use, with limited guidance on preferred pharmacological agents.

OBJECTIVE

Evaluate the efficacy and safety of lidocaine compared to other pharmacologic agents for reducing pain during IUD insertion.

SEARCH STRATEGY: Electronic database searches were conducted in August 2025 and included randomized controlled trials (RCTs) published between January 1984 and August 2025.

SELECTION CRITERIA: RCTs involving women or adolescents that evaluated the efficacy and safety of lidocaine versus other pharmacologic agents for reducing IUD insertion pain.

DATA COLLECTION AND ANALYSIS: Conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomized Trials (RoB-2) and meta-analysis was conducted on 5 of the 6 studies using Meta-Analysis version 4.0.2.

MAIN

RESULTS

Six studies (N = 658) compared lidocaine to non-steroidal anti-inflammatory drugs (NSAIDs) or misoprostol. Of these, two studies showed statistically significant pain reduction with lidocaine versus NSAIDs (study 1: 5.4 ± 2.8 vs. 7.3 ± 2.1, p < 0.001; study 2: 2.6 ± 0.9 vs. 4.1 ± 1.1, p < 0.001). The meta-analysis showed no statistically significant pain reduction with lidocaine overall.

CONCLUSIONS

Lidocaine did not demonstrate a statistically significant reduction in pain. It remains unclear whether lidocaine, NSAIDs, and misoprostol are clinically comparable options. Secondary outcomes varied, and safety data were limited, highlighting the need for standardized endpoints. Further head-to-head trials are needed to guide optimal pain management for IUD insertion.