• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

Does Intracervical Block During IUD Insertion Decrease Pain in Nulliparous Women?

image_pdfFavoriteLoadingFavorite

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

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More  »

image_pdfFavoriteLoadingFavorite
< Previous
All #Grand Rounds Posts
Next >

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?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site