A Cochrane review included 23 studies with a total of 1 272 subjects.
Oral opioid analgesia did not reduce pain during the procedure or more than 30 minutes after the procedure in study (n=128) compared with placebo. Intravenous opioids improved pain relief during the procedure compared to no treatment in one sudy (n=62). There was no difference between the groups when oral non-opioid analgesia was compared to opioid analgesia for pain relief during the procedure, less than 30 minutes following the procedure and more than 30 minutes following the procedure.
Oral non-opioid analgesia compared with placebo did not reducing pain during the procedure (MD −0.13, 95% CI −0.48 to 0.23; 3 studies, n=133, I² = 61%, low quality evidence) or more than 30 minutes after the procedure (MD −0.36, 95% CI −1.06 to 0.34; 3 studies, n=133, I² = 58%, low quality evidence).
Topical anaesthetics reduced pain during the procedurecompared with placebo (MD −0.63, 95% CI −1.06 to −0.19; 9 studies, n=613, I²=66%, low quality evidence). However, there was no evidence of effect for topical anaesthesia, when applied prior to the procedure, in reducing pain less than 30 minutes after the procedure (MD 0.42, 95% CI -0.03 to 0.86; 5 studies, n=373, I²=59%, very low quality evidence) or reducing pain more than 30 minutes after the procedure (MD −1.38, 95% CI -3.44 to −0.68; 2 studies, n=166, I²=92%, very low quality evidence).
Locally injected anaesthetic reduced pain during the procedure (MD −1.31, 95% CI −1.55 to −1.07; 2 studies, n=125, I²=0%, very low quality evidence). Locally injected anaesthesia, when applied prior to the procedure, did not reduce pain less than 30 minutes after the procedure (MD −1.31, 95% CI −2.14 to −0.49; 2 studies, n=125, I²=46%, low quality evidence).
Topical analgesia was more effective than paracervical block in one small trial.
Comment: The quality of evidence is downgraded by imprecise results; few patients and wide confidence intervals.