BACKGROUND AND PURPOSE:

• Nadai et al. (AJOG, 2019) evaluated whether a lidocaine intracervical block reduces pain at tenaculum placement and IUD insertion among nulligravidas

METHODS:

• Randomized, double-blind, controlled trial (RCT)
• Participants
  • Nulligravid women 
  • 52mg levonorgestrel-releasing IUD
• Interventions
  • 3.6mL 2%-lidocaine intracervical block
  • Sham injection (intracervical dry-needling)
  • No intervention
• Procedure for block
  • 3.6 mL of 5 2% lidocaine (72mg) without vasoconstricting agents | Prior to tenaculum placement
  • Dental carpule 6 syringe (2 tubes of 1.8mL of 2% lidocaine) | 27 gauge needle
  • Injection x 4 around the cervix at 3, 6, 9, and 12 o’clock
• Data analysis
  • Pain measurement
    • 10-cm visual analog scale | Five-point Faces scale
  • The number needed to treat for the intracervical block to avert severe pain at tenaculum placement and IUC insertion was calculated
• Primary outcome
  • Pain at insertion
• Secondary outcomes
  • Pain at tenaculum placement
  • Ease of insertion
  • Overall experience with the procedure: Patient expectations | Discomfort level, Desire to undergo IUD insertion in the future | Willingness to recommend procedure to others

RESULTS:

• 302 participants randomized | 300 women had successful insertion
  • Intracervical block: 99 | Intracervical sham: 101 | No intervention: 102

Severe pain was less frequent with intracervical block

• At tenaculum placement (p<0.0001)
  • Intracervical block: 2%
  • Sham: 30.2%
  • No intervention: 15.2%
• At IUC insertion (p<0.0001)
  • Intracervical block: 26.5%
  • Sham: 59.4%
  • No intervention: 50.5%

Average pain score

• Average pain score at insertion was lower in the intracervical block group (p<0.0001 for both comparisons)
  • Intracervical block: 4.3 (95% CI, 3.8 to 4.9) vs sham: 6.6 (95% CI, 6.2 to 7.0)
  • Intracervical block: 4.3 (95% CI, 3.8 to 4.9) vs no intervention: 5.8 (95% CI, 5.3 to 6.4)

Other secondary outcomes

• Intracervical block group reported
  • Less pain than expected (p<0.0001)
  • Insertion less uncomfortable (p<0.0001)
  • Were more willing to undergo another device insertion in the future (p<0.01)
• Ease of insertion was similar among groups
• Number-needed-to-treat: One intracervical block would avert
  • Severe pain at tenaculum placement in 2 patients
  • Severe pain with IUD insertion in 4 patients

CONCLUSION:

• Intracervical lidocaine block resulted in less tenaculum and IUD insertion pain and reported a more positive experience  

Learn More – Primary Sources:

Intracervical block for levonorgestrel-releasing intrauterine system placement among nulligravid women: a randomized double-blind controlled trial

Related ObG Topics:

ACOG & SMFM Guidance on the Use of IUDs and Contraceptive Implants

Can 1% Lidocaine Reduce Pain During IUD Insertion in Nulliparous Women?

Does Self-Administered Lidocaine Gel Reduce Pain During IUD Insertion?

Can lidocaine gel replace paracervical block for gyn procedures?