Efficacy and Safety of Paracervical Block in Reducing Intrauterine Device Insertion Related Pain : A Randomized Controlled Trial

Abstract

Objective: To assess the efficacy and safety of 20 ml of 1 % buffered lidocaine paracervical block to reduce pain during IUCD placement. Materials and Methods: In randomized single blinded controlled trial, women were assigned to receive either a 20 ml buffered lidocaine or no block before IUCD insertion. Enrollment occurred at family planning clinic, Badr University Hospital. The primary outcome was pain measured with a 100-mm visual analogue scale in various steps of IUD insertion. Results: From January to july 2021, 138 women were enrolled and distributed randomly into two equal groups: group I (intervention group) included 70 women received paracervical block before IUCD insertion in form of lidocaine injection, and group II (no intervention) included 68 women. There were no differences in demographic characteristics of both groups. Women who received the paracervical block reported less pain with IUD insertion compared to women who received no block( median VAS score of 20.9 mm versus 37.4 mm, p<0.001). Pain with tenaculum placement was less in intervention group (28.9mm versus 58.4mm, p <0.001). Pain with paracervical block administration was higher for intervention group compared to the no paracervical block group (18.4mm versus 10.9mm, p<0.001). The mean pain intensity felt 5 minutes after IUD placement was (5.9mm versus 16.9mm, p<0.001) which is statistically significant. The intensity of pain was similar and there was no statistically significant difference in the median VAS scores at baseline pain or pain with speculum insertion (51mm compared with 53.4 mm, p= 0.196). Conclusion: 20 ml lidocaine 1% paracervical block prior to copper T380A IUD insertion significantly decrease the related pain perception when compared with no block group.