Evaluation of an effective and cheap analgesic protocol prior to intra-uterine device insertion in a developing country

Abstract

Background: Intrauterine (contraceptive) device (IUD) insertion is a common outpatient gynecologic procedure. This study aimed to evaluate the effect of premedication with oral drotaverine-mefenamic acid on pain perception during IUD insertion. Methods: Double blinded placebo controlled randomized trial involving fifty six women undergoing IUD insertion in outpatient clinic, randomized into 2 groups. Group I (n=31) received tablet containing drotaverine hydrochloride (80 mg) + mefenamic acid (250 mg), group II (n=25) received placebo. The intensity of pain during the procedure, 15 and 30 minutes later was assessed on visual analog scale (VAS). Kruskal-Wallis test, with the Bonferroni correction, the t test, analysis of variance (ANOVA) and the $χ$2 test were used for statistical analysis. Results: Groups were similar demographically. A significant difference in pain scores was noted among the 2 groups during the procedure (group I, 2.32±1.137; group II, 4.32±1.676 ( P= 0.001 ), 15 minutes later (group I, 1.28± 0.59; group II 2.01± 0.93), (P= 0.001) and 30 minutes later (group I, 0.97±0.948; group II, 1.72±1.339; ( P=0.012 ). No significant adverse effects were observed. A post hoc analysis revealed adequate power. Conclusions: Oral drotaverine-mefenamic acid provides a cheap option for effective analgesia prior to IUD insertion in clinic.