Lidocaine for pain control during intrauterine device insertion

Abstract

Lidocaine spray is a good option for reducing the pain experienced during insertion of an IUD. It reduces pain related to both tenaculum use and IUD insertion. Spray application is both easy and rapid. Paracervical lidocaine injection also reduces pain during IUD insertion, but has no effect on tenaculum-related pain; moreover, the injection itself is painful. Therefore, this option is not a plausible method for reducing pain during IUD insertion.

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

“…However, there was an increase in pain associated with the lidocaine injection (30 vs 8 mm, P = 0.003) . The study by Karasu et al described above found that 10 mL 2% lidocaine injection, a dose higher than that used in most clinics, led to a lower mean pain score at placement when compared with LP cream and control (no anesthesia) (2.9 ± 1.4 vs 4.0 ± 1.7 vs 4.25 ± 1.9) but no difference in the proportion of women experiencing no pain at placement (2.1% vs 1.9% vs 2.0%). Two RCTs comparing lidocaine paracervical block with nonsteroidal anti‐inflammatory drugs (NSAIDs) and placebo (400 mg ibuprofen and 500 mg oral naproxen/placebo, respectively) found no differences in mean pain scores during placement …”

“…Two RCTs reported lower placement‐related pain scores with lidocaine spray (net 40 mg) when compared with 2 g lidocaine cream or 10 mL lidocaine (20 mg/mL) injection and placebo . 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).…”

“…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 …”

“…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. Karasu et al discussed the variability in dosing options for all three lidocaine preparations used in the study and the risks involved in increasing doses over and above those routinely used in gynecological practice. A nonrandomized study compared the effect of cervical lidocaine spray, cervical lidocaine gel and no topical anesthesia in 420 women: mean pain scores were 1‐1.5 cm lower with the use of lidocaine preparations compared with no anesthetic …”

“…Three RCTs evaluated the effect of lidocaine paracervical block on pain experienced with IUC placement . Akers et al found there to be a 41.5 mm reduction in mean pain score when comparing injection of 1% lidocaine with a sham control in nulliparous women ( P = 0.006).…”