TY - JOUR
T1 - Intracervical lidocaine gel for intrauterine device insertion
T2 - A randomized controlled trial
AU - Maguire, Karla
AU - Davis, Anne
AU - Rosario Tejeda, Linette
AU - Westhoff, Carolyn
N1 - Funding Information:
Conflicts of interest: Karla Maguire, M.D., M.P.H.: no conflicts of interest to disclose. Anne Davis, M.D., M.P.H.: Bayer (honoraria for advisory board, research support) Merck (honoraria for training). Linette Rosario Tejeda, M.D.: no conflicts of interest to disclose. Carolyn Westhoff, M.D., M.Sc.: Duramed (board membership, advisory board), Merck [consultant, grant (investigator initiated, Nuvaring study)], Bayer (consultant), Pfizer [grant (investigator initiated, Depo study)].
PY - 2012/9
Y1 - 2012/9
N2 - Background: Pain during intrauterine device (IUD) insertion can be a barrier to initiation. Clinical trials have found misoprostol and nonsteroidal drugs to be ineffective (Am J Obstet Gynecol 2006;195:1272-1277, Hum Reprod 2011;26:323-329, Hum Reprod 2007;22:2647-2652). One study suggested that 2% lidocaine gel decreased pain; however, study design problems limit its validity (Brit J Fam Plann 1996;22:177-180). We tested whether intracervical 2% lidocaine gel decreased insertion pain compared to placebo. Study Design: We planned a randomized, double-blinded clinical trial of 200 women. We placed 2% lidocaine gel or placebo in the cervix prior to uterine sounding. Participants rated pain by marking a 100-mm visual analogue scale at four time points. Results: We randomized 200 participants and placed 197 IUDs. Pain was greatest at uterine sounding and similar between groups: placebo group mean 51.6 mm (SD 25), lidocaine group mean 55.5 mm (SD 30, p=.33). Stratified analyses accounting for parity showed no treatment effect. Multivariable analyses identified longer time since last pregnancy, lower parity and higher anticipated pain as predictors of pain during sounding, and dysmenorrhea and the levonorgestrel IUD as additional predictors during IUD insertion. Conclusions: Intracervical 2% lidocaine gel does not decrease IUD insertion pain. Understanding predictors of increased pain may help providers with preprocedure counseling.
AB - Background: Pain during intrauterine device (IUD) insertion can be a barrier to initiation. Clinical trials have found misoprostol and nonsteroidal drugs to be ineffective (Am J Obstet Gynecol 2006;195:1272-1277, Hum Reprod 2011;26:323-329, Hum Reprod 2007;22:2647-2652). One study suggested that 2% lidocaine gel decreased pain; however, study design problems limit its validity (Brit J Fam Plann 1996;22:177-180). We tested whether intracervical 2% lidocaine gel decreased insertion pain compared to placebo. Study Design: We planned a randomized, double-blinded clinical trial of 200 women. We placed 2% lidocaine gel or placebo in the cervix prior to uterine sounding. Participants rated pain by marking a 100-mm visual analogue scale at four time points. Results: We randomized 200 participants and placed 197 IUDs. Pain was greatest at uterine sounding and similar between groups: placebo group mean 51.6 mm (SD 25), lidocaine group mean 55.5 mm (SD 30, p=.33). Stratified analyses accounting for parity showed no treatment effect. Multivariable analyses identified longer time since last pregnancy, lower parity and higher anticipated pain as predictors of pain during sounding, and dysmenorrhea and the levonorgestrel IUD as additional predictors during IUD insertion. Conclusions: Intracervical 2% lidocaine gel does not decrease IUD insertion pain. Understanding predictors of increased pain may help providers with preprocedure counseling.
KW - Intrauterine device insertion
KW - IUD insertion
KW - Pain
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U2 - 10.1016/j.contraception.2012.01.005
DO - 10.1016/j.contraception.2012.01.005
M3 - Article
C2 - 22325115
AN - SCOPUS:84865065873
VL - 86
SP - 214
EP - 219
JO - Contraception
JF - Contraception
SN - 0010-7824
IS - 3
ER -