Cervical lidocaine for IUD insertional pain: a randomized controlled trial

Abstract

Objective Anticipated pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. Study Design We performed a double-blind, randomized controlled trial of women undergoing IUD insertion. Participants were randomly assigned to 2% lidocaine or placebo gel. Study gel (3ccs) wase placed 3 minutes prior to IUD insertion. Pain scores were measured at various time points using a 10-point visual analog scale. Results Of the 200 participants randomized, 199 completed the study. Pain scores among lidocaine and placebo arms were similar at tenaculum placement (lidocaine and placebo; median 4, range 0–10 p=0.15) as well as with insertion (lidocaine: median 5 range 1–10, placebo: median 6 range 0–10 p=0.16). These results did not differ by parity. Conclusions Topical or intracervical 2% lidocaine gel prior to IUD insertion does not decrease pain scores.

Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial

“…However, reducing pain with IUD insertion among nulliparous women may increase the acceptability of this highly effective contraceptive method for this group. NSAIDs, intracervical lidocaine [28], nitric oxide donors [21,22] and misoprostol [29] have all been studied, but none have been shown to be effective. Given the important public health need to reduce barriers to IUD utilization overall, further investigations should concentrate on alternate strategies to reduce pain and improve satisfaction with IUD insertion among nulliparous women.…”

Pain Management for Gynecologic Procedures in the Office

“…Several randomized controlled trials examined the use of 2% lidocaine gel placed intracervically prior to tenaculum placement and IUD insertion. 18,19,46 None of the studies found improvement in pain scores with tenaculum placement or IUD insertion. Nelson and Fong 47 conducted a randomized controlled pilot study of 40 women to examine the 92 Obstetrical and Gynecological Survey use of 1.2 mL of 2% lidocaine infused intrauterine prior to IUD insertion compared with saline.…”

“…The use of 2% lidocaine gel on the anterior lip of the cervix 3 minutes prior to tenaculum placement has been found to be no better than placebo gel in studies of IUD insertion. 18,19 On the other hand, 2 mL of injected 1% lidocaine decreased pain during tenaculum placement when compared with no injection in a trial evaluating paracervical block for IUD insertion. 20 Furthermore, a recent randomized controlled trial among 70 women compared a 2-mL injection of 1% lidocaine and 1 mL of 2% lidocaine gel to the anterior lip of the cervix for tenaculum placement.…”

Paracervical block with 1% lidocaine for pain control during intrauterine device insertion: a prospective, single-blinded, controlled study

“…6,7,8 McNicholas et al randomized 199 women to either Lidocaine or placebo gel groups and applied gels to both ectocervix and endocervix (via catheter). 9 Tenaculum and IUD were applied 3 minutes after the gel is used, and pain scores were found to be statistically similar. Short waiting time in this study may be speculated to limit diffusion of the gel to the sensory nerves.…”