Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis.

OBJECTIVE: To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). DESIGN: Systematic review and network meta-analysis of randomized controlled trials. SETTING: Not applicable. PATIENT(S): Pre- or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. INTERVENTION(S): We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). MAIN OUTCOME MEASURE(S): The intensity of pain during, immediately after, and 10-30 minutes after procedure assessed by the 10-cm visual analog scale. RESULT(S): Lidocaine spray was the most effective medication for reducing pain during OEB (P-score = 0.83) and immediately after OEB (P-score = 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score = 1.00), followed by misoprostol plus lidocaine (P-score = 0.87). CONCLUSION(S): Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA.