利多卡因用于 IUD 放置镇痛：系统评价与荟萃分析
本系统评价与荟萃分析纳入 6 项 RCT（N=658），比较利多卡因与 NSAIDs 或米索前列醇对 IUD 放置疼痛的效果。其中 2 项研究显示利多卡因组疼痛评分低于 NSAIDs 组（P<0.001），但荟萃分析总体未显示利多卡因有统计学显著的疼痛减轻。利多卡因、NSAIDs 与米索前列醇在临床上是否等效尚不明确。
要点
- 荟萃分析总体未显示利多卡因相比其他药物能显著减轻 IUD 放置疼痛。
- 安全性数据有限，不同研究间的次要结局差异较大。
- 尚需更多头对头试验来指导 IUD 放置的最佳镇痛方案。
核心结论
- 荟萃分析未显示利多卡因能显著减轻 IUD 放置疼痛。
- 利多卡因、NSAIDs 和米索前列醇是否为临床等效选择仍不明确。
研究设计与样本
- 系统评价与荟萃分析，检索时间截至 2025 年 8 月，文献纳入范围为 1984 年 1 月至 2025 年 8 月发表的 RCT。
- 采用 PRISMA 方法学，使用 Cochrane RoB-2 评估偏倚风险，对 6 项研究中的 5 项进行荟萃分析。
主要发现
- 共纳入 6 项 RCT（N=658），比较利多卡因与 NSAIDs 或米索前列醇。
- 2 项研究显示利多卡因疼痛评分低于 NSAIDs（研究 1：5.4±2.8 vs. 7.3±2.1，P<0.001；研究 2：2.6±0.9 vs. 4.1±1.1，P<0.001）。
- 荟萃分析总体未显示利多卡因有统计学显著的疼痛减轻。
- 不同研究间次要结局差异较大，安全性数据有限。
关键数值与推荐
- 纳入标准：女性或青少年，评估利多卡因与其他药物减少 IUD 放置疼痛有效性与安全性的 RCT。
临床怎么用
- 现有证据不支持常规使用利多卡因作为 IUD 放置的首选镇痛药物。
- 临床需结合患者个体情况和可用药物选择镇痛方式，并关注后续头对头试验的更新证据。
局限性
- 仅纳入 6 项研究，样本总量 658 例。
- 安全性数据有限，次要结局在各研究间不一致。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT 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.
引用
- BJOG：Efficacy and Safety of Lidocaine Compared to Other Agents for Intrauterine Device Insertion Pain: A Systematic Review and Meta‐Analysis
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。