Lidocaine 10% spray to the cervix reduces pain during intrauterine device insertion: a double-blind randomised controlled trial

Abstract

ObjectiveFear of pain during intrauterine device (IUD) insertion can be a barrier to widespread use of this safe and highly effective contraceptive method. Our objective was to determine the effectiveness of topical 10% lidocaine spray for pain control during IUD insertion.MethodsA total of 200 subjects with the request for IUD insertion were included in the study. The patients were randomly divided into two groups: lidocaine spray (n=100) and placebo (n=100). The pain experienced during the procedure was measured immediately after insertion by a standard Visual Analogue Scale (VAS) administered by a separate researcher with maintenance of allocation concealment.ResultsThe mean pain score during the procedure was 1.01±1.20 in the lidocaine spray group and 3.23±1.60 in the placebo spray group (p<0.001). Lidocaine spray treatment significantly lowered the overall procedural pain score compared with placebo.ConclusionsSignificant pain reduction during IUD insertion can be achieved by using 10% lidocaine spray alone. Lidocaine spray can be accepted as a non-invasive, easy to apply and more comfortable local anaesthetic method for IUD insertion.Trial registration numberNCT02020551.

Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review

“…In the study by Karasu et al, a greater number of women in the lidocaine spray group reported no pain with placement compared with the injection and cream group (25.5% vs 1.9% vs 2.1%; P < 0.001). In the study by Aksoy et al, use of lidocaine spray reduced mean pain scores by 2.2 cm when compared with placebo (1.01 ± 1.20 vs 3.23 ± 1.60, P > 0.001). The authors also found a 35% reduction in the number of women scoring ≥ 4 on the 10‐cm VAS (6% vs 41%, P < 0.001) .…”

“…In the study by Aksoy et al, use of lidocaine spray reduced mean pain scores by 2.2 cm when compared with placebo (1.01 ± 1.20 vs 3.23 ± 1.60, P > 0.001). The authors also found a 35% reduction in the number of women scoring ≥ 4 on the 10‐cm VAS (6% vs 41%, P < 0.001) . Neither study involved nulliparous women, nor did they assess pain at time‐points other than IUC placement, an observation noted by Aksoy et al as being useful in evaluating the delayed prostaglandin‐related cramping response that many women can experience.…”

“…Interventions included lidocaine gel, lidocaine‐prilocaine (LP) cream, lidocaine intracervical block, lidocaine infusion, and nitroglycerin gel. Nine RCTs reported lower VAS pain scores in the treatment group compared with the control/placebo group …”

Medications to ease intrauterine device insertion: a systematic review

“…Four studies were excluded because either they only included IUDs never available in the United States [40–42] or the majority of IUDs studied were never available in the United States [43]. Thirteen studies [13,14,44–54] were excluded because they only reported on patient outcomes (e.g., pain during IUD insertion) and have already been summarized in a recent systematic review [15]. One case series that examined second-attempt insertion success among women receiving misoprostol after a failed first-attempt insertion was excluded due to study design [55].…”

Intrauterine levobupivacaine for pain control during intrauterine device insertion

“…22,23 Nevertheless, there are studies being published which show that topical use of different formulations involving high concentrations of lidocaine mitigates IUD insertion pain at every step of the procedure. [24][25][26] It was shown that paracervical blockage in injectable applications of local anesthetics mitigates IUD application pain but intracervical injectival application is not effective on the pain. 3,27 In consideration of injection's own pain and possible adverse reactions, topical application of local anesthetics is regarded as being more advisable.…”