Daykan Yair, Battino Shlomo, Arbib Nissim, Tamir Yaniv Rina, Schonman Ron, Klein Zvi, Pomeranz Jonathan, Pomeranz Meir
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Women's Health Center Clalit Afula, Israel; Galilee Medical Centre, Galilee Faculty of Medicine, Safed, Israel.
Eur J Obstet Gynecol Reprod Biol. 2021 Mar;258:443-446. doi: 10.1016/j.ejogrb.2020.09.019. Epub 2020 Sep 16.
To compare two pain management strategies: oral tramadol or a verbal analgesia technique during insertion of an intrauterine device (IUD) among nulliparous women.
In this randomized, controlled trial, 54 nulliparous women undergoing insertion of a levonorgestrel-releasing intrauterine device (IUD), from December 2015 to December 2018 were randomized to receive oral tramadol for analgesia or verbal analgesia prior to IUD insertion. Demographic data, clinical symptoms, visual analogue scale (VAS) and complications were reviewed from patient records.
There was no difference between the two groups regarding gravidity, age, smoking or body mass index. No significant differences were detected between the groups regarding the procedure, including ease of insertion (p = .415), number of insertion attempts (p = .514) and complications during the insertion (p = .150). Mean pain level by VAS was 4.5 ± 1.6 (range 2-8) for the tramadol group and 4.8 ± 2.4 (0-10) for the verbal analgesia group (p = .610). There was no spontaneous ejection of the IUD in either group, and no endometritis or discomfort that resulted in IUD removal.
There was no benefit in using oral tramadol for analgesia prior to IUD insertion among nulliparous women. Verbal analgesia can be a suitable technique for this process and clinicians should become more familiar with its use.
比较两种疼痛管理策略：未生育女性宫内节育器（IUD）放置过程中口服曲马多或采用语言镇痛技术。
在这项随机对照试验中，2015年12月至2018年12月期间，54名接受左炔诺孕酮宫内节育器（IUD）放置的未生育女性被随机分为两组，分别在IUD放置前接受口服曲马多镇痛或语言镇痛。从患者记录中回顾人口统计学数据、临床症状、视觉模拟评分（VAS）和并发症情况。
两组在妊娠次数、年龄、吸烟情况或体重指数方面无差异。两组在手术过程方面未检测到显著差异，包括放置难易程度（p = 0.415）、放置尝试次数（p = 0.514）和放置过程中的并发症（p = 0.150）。曲马多组VAS平均疼痛水平为4.5±1.6（范围2 - 8），语言镇痛组为4.8±2.4（0 - 10）（p = 0.610）。两组均未出现IUD自行排出情况，也没有因子宫内膜炎或不适而导致取出IUD的情况。
未生育女性在IUD放置前使用口服曲马多镇痛并无益处。语言镇痛可作为该过程的一种合适技术，临床医生应更熟悉其使用方法。
