Lidocaine for pain control during intrauterine device insertion

Aim: The aim of this study was to compare the effects of topical lidocaine spray, cream and injection on pain perception during intrauterine device (IUD) insertion.

Methods: Multiparous women of reproductive age were randomized into control, lidocaine cream, spray and injection groups. A 10 cm visual analog scale was used for all patients to evaluate pain during the three steps of the IUD insertion procedure. Baseline pain assessment was made immediately after the administration of analgesics, the second pain assessment was performed immediately after use of the tenaculum, and the third pain assessment was performed after IUD insertion.

Results: Two hundred patients were enrolled in the study. The groups were similar in terms of demographic characteristics. The lidocaine injection group exhibited higher baseline pain scores (P < 0.001). Pain associated with tenaculum use was lower in the lidocaine spray group. Pain related to IUD insertion was lower in the lidocaine spray and injection groups (P < 0.001); however, lidocaine spray was superior to injection for the reduction of IUD insertion related pain (P = 0.001).

Conclusion: 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.