We searched the Menstrual Disorders and
Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL (from their inception to present); the National Research Register and Current Controlled Trials. We searched reference lists of included studies for relevant studies and contacted authors for information on unpublished and ongoing trials. There was no language restriction. The search was updated in July 2012.
SELECTION CRITERIA: Quality assessment and data extraction were performed independently by two review authors. Interventions were classified and analysed under broad categories or strategies of sedation and
pain relief to compare different methods and administrative protocols of
conscious sedation and
analgesia. Outcomes were extracted and the data were pooled when appropriate.
MAIN RESULTS: With this update, nine new studies were identified resulting in a total of 21 trials including 2974 women undergoing oocyte retrieval. These trials compared five different categories of
conscious sedation and
analgesia: 1)
conscious sedation and
analgesia versus placebo; 2)
conscious sedation and
analgesia versus other active interventions such as general and acupuncture anaesthesia; 3)
conscious sedation and
analgesia plus
paracervical block versus other active interventions such as general, spinal and acupuncture anaesthesia; 4) patient-controlled
conscious sedation and
analgesia versus physician-administered
conscious sedation and
analgesia; and 5)
conscious sedation and
analgesia with different agents or dosage. Evidence was generally of low quality, mainly due to poor reporting of methods, small sample sizes and inconsistency between the trials.Conflicting results were shown for women's experience of
pain. Compared to
conscious sedation alone, more effective
pain relief was reported when
conscious sedation was combined with electro-acupuncture: intra-operative
pain mean difference (MD) on 1 to 10 visual analogue scale (VAS) of 3.00 (95% CI 2.23 to 3.77);
post-operative pain MD in VAS units of 2.10 (95% CI 1.40 to 2.80; N = 61, one trial, low quality evidence); or
paracervical block (MD not calculable).The pooled data of four trials showed a significantly lower intra-operative
pain score with
conscious sedation plus
paracervical block than with electro-acupuncture plus
paracervical block (MD on 10-point VAS of -0.66; 95% CI -0.93 to -0.39; N = 781, 4 trials, low quality evidence) with significant statistical heterogeneity (I(2) = 76%). Patient-controlled sedation and
analgesia was associated with more intra-operative
pain than physician-administered sedation and
analgesia (MD on 10-point VAS of 0.60; 95% CI 0.16 to 1.03; N = 379, 4 trials, low quality evidence) with high statistical heterogeneity (I(2) = 83%).
Post-operative pain was reported in only nine studies. As different types and dosages of
sedative and
analgesic agents, as well as administrative protocols and assessment tools, were used in these trials the data should be interpreted with caution.There was no evidence of a significant difference in pregnancy rate in the 12 studies which assessed this outcome, and pooled data of four trials comparing electro-acupuncture combined with
paracervical block with
conscious sedation and
analgesia plus
paracervical block showed an odds ratio (OR) of 0.96 (95% CI 0.72 to 1.29; N = 783, 4 trials) for pregnancy. High levels of women's satisfaction were reported for all modalities of
conscious sedation and
analgesia as assessed in 12 studies. Meta-analysis of all the studies was not attempted due to considerable heterogeneity.For the rest of the trials a descriptive summary of the outcomes was presented.
AUTHORS' CONCLUSIONS: The evidence from this review of 21 randomised controlled trials did not support one particular method or technique over another in providing effective
conscious sedation and
analgesia for
pain relief during and after oocyte recovery. The simultaneous use of more than one method of sedation and
pain relief resulted in better
pain relief than one modality alone. The various approaches and techniques reviewed appeared to be acceptable and were associated with a high degree of satisfaction in women. As women vary in their experience of
pain and in coping strategies, the optimal method may be individualised depending on the preferences of both the women and the clinicians and resource availability.