Ketorolac for Pain Control With Intrauterine Device Placement: A Randomized Controlled Trial

Abstract

Objective: To evaluate intramuscular ketorolac compared with placebo saline injection for pain control with intrauterine device (IUD) placement.

Methods: We conducted a randomized, double-blind, placebo-controlled trial between July 2012 and March 2014. Patients received 30 mg ketorolac or placebo saline intramuscular injection 30 minutes before IUD placement. The primary outcome was pain with IUD placement on a 10-cm visual analog scale. Sample size was calculated to provide 80% power to show a 2.0-cm difference (α=0.05) in the primary outcome. Secondary outcomes included pain with study drug injection, speculum insertion, tenaculum placement, uterine sounding, and at 5 and 15 minutes after IUD placement.

Results: A total of 67 women participated in the study, 33 in the ketorolac arm and 34 in the placebo arm. There were no differences in baseline demographics including age, body mass index, and race. There were no differences in median pain scores for IUD placement in the placebo compared with ketorolac groups (5.2 compared with 3.6 cm, P=.99). There was a decrease in median pain scores at 5 minutes (2.2 compared with 0.3 cm, P≤.001) and 15 minutes (1.6 compared with 0.1 cm, P≤.001) after IUD placement but no difference for all other time points. Nulliparous participants (n=16, eight per arm) had a decrease in pain scores with IUD placement (8.1 compared with 5.4 cm, P=.02). In this study, 22% of participants in the placebo group and 18% in the ketorolac group reported injection pain was as painful as IUD placement.

Conclusion: Ketorolac does not reduce pain with IUD placement but does reduce pain at 5 and 15 minutes after placement.

Clinical trial registration: ClinicalTrials.gov; www.clinicaltrials.gov, NCT01664559.

Level of evidence: I.

Conflict of interest statement

Financial Disclosures: The other authors did not report any potential conflicts of interest.

Figures

Figure 1

Study flowchart. Out of 110 women who were approached for eligibility, a total of 67 were included in the analysis. All allocated participants received their assigned study drug. IUD, intrauterine device.

Figure 2

Visual analog scale pain scores for all time points. Median pain scores with interquartile ranges (25%, 75%) comparing the placebo and ketorolac groups for (A) the entire sample and (B) the nulliparous subgroup. *P< 0.05. IUD, intrauterine device.