Well-Placed Lidocaine Can Reduce Discomfort Associated with IUD Insertion

Summary and Comment |
September 19, 2017

Well-Placed Lidocaine Can Reduce Discomfort Associated with IUD Insertion

  1. Robert L. Barbieri, MD

Lidocaine paracervical block decreased self-reported pain during and after IUD placement in teens and young women.

  1. Robert L. Barbieri, MD

Although intrauterine devices (IUDs) represent one of the most effective birth control options, fear of painful insertion leads some women to avoid this approach to contraception. To assess the effect of a lidocaine paracervical block on pain during IUD placement, investigators randomized 95 nulliparous teens and young women (80% aged 18–22) seeking a levonorgestrel IUD to receive 1% lidocaine or sham paracervical block at placement. All participants received 800-mg oral ibuprofen. The lidocaine block was administered at the tenaculum site and the cervicovaginal junction; for the sham block, pressure was applied at these sites with the wooden end of a cotton-tipped applicator. Participants, but not clinicians, were blinded to the intervention. Subjects were asked to rate their pain using a 100-mm visual analog scale while on the examination table (baseline); during placement of the speculum, tenaculum, and paracervical block; during uterine sounding and IUD insertion; and 5 minutes after speculum removal.

A 13.5-mg levonorgestrel-releasing IUD (Skyla) was successfully placed in all participants. Cervical dilation was necessary for three women in the lidocaine group and one in the sham group. At baseline, median pain score was 3 in both groups. Immediately following IUD placement, median pain scores were 30 versus 72 in the lidocaine and sham groups, respectively (P<0.001). Satisfaction with the procedure was similarly favorable in both groups.

Comment

This study demonstrates that IUDs can be successfully placed with little discomfort in most adolescents and young women: Administering a lidocaine paracervical block before placement significantly reduced self-reported pain (in contrast to vaginal lidocaine gel, which was not effective in a previous study; NEJM JW Womens Health Sept 2016 and Obstet Gynecol 2016; 128:621). Offering such an analgesic intervention is but one component of a multifaceted effort to boost the use of this highly effective reversible contraceptive.

Editor Disclosures at Time of Publication

  • Disclosures for Robert L. Barbieri, MD at time of publication Editorial boards UpToDate; OBG Management

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