Lidocaine nerve block useful for easing pain during IUD insertion
Use of a 10-mL 1% lidocaine paracervical nerve block may substantially reduce pain during insertion of an intrauterine device (IUD) in adolescents and young women relative to a sham block with pressure on the vaginal epithelium, a study has shown.
The trial included 95 young women aged 14 to 22 years who had a 13.5-mg levonorgestrel IUD inserted, were nulliparous, and not currently or recently pregnant. Of these, 47 were randomly assigned to the lidocaine block group and 48 in the sham block group.
Resulting data showed that the primary outcome of pain after IUD insertion, measured with a 100-mm visual analogue scale (VAS), was significantly lower in the lidocaine block group than in the sham block group (mean VAS score, 30.0 vs 71.5; p<0.001).
The lidocaine block group received 1 mL of 1% lidocaine at the tenaculum site and 4.5 mL in the 4- and 8-o’clock positions at the cervicovaginal junction. To allow onset of action for the drug, IUD was inserted after 3 minutes of lidocaine application.
On the other hand, the sham block group received pressure to the same three sites using the unbroken, wood end of a cotton-tipped applicator to depress the vaginal epithelium 1 centimetre.
The present data have important implications considering the low uptake of IUD use among young women, which is largely driven by concerns about pain during the procedure, researchers said.
“By demonstrating the effectiveness of a pain management option for young, nulliparous women that is easy to perform, our findings could reduce patient concerns about pain and increase IUD use, which is known to reduce rates of unintended pregnancies, births and abortions in this population,” they added.