10% lidocaine spray for pain control during intrauterine device insertion: a randomised, double-blind, placebo-controlled trial

Correspondence to Dr Nalinee Panichyawat, Obstetrics and Gynecology, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand; [email protected]

Key messages

• There is no recommendation to reduce pain during intrauterine device (IUD) insertion. Few studies investigated the efficacy of 10% lidocaine spray for pain reduction during IUD insertion.

• Women who received 10% lidocaine spray reported significantly less pain than placebo during IUD insertion, especially during tenaculum placement, uterine sounding and after IUD placement.

• 10% lidocaine spray should be considered a safe, convenient and effective anaesthetic option for reducing pain during IUD insertion in both nulliparous and multiparous women.

Introduction

Copper-containing intrauterine device (Cu-IUD) is a highly effective long-acting reversible contraceptive method that was reported to have a 0.8% rate of unintended pregnancy during the first year of typical use.¹ Despite the advantages of this non-hormonal method of contraception, the rate of Cu-IUD use was estimated to be 14% among reproductive-age women worldwide, and its use varies widely among countries and regions.² One of the main limitations of Cu-IUD is patient concern about pain during the insertion procedure. Pain may occur during several steps of the procedure, including applying the tenaculum to the cervix, passing the uterine sound to measure the depth of the uterus and insertion of the IUD inserter tube. Several studies have investigated pain during IUD insertion, and the reported results are variable.^3–5

According to a 2015 Cochrane Review, lidocaine gel, some non-steroidal anti-inflammatory drugs and misoprostol were ineffective for reducing pain during IUD insertion, while some lidocaine preparations and naproxen decreased IUD insertion-related pain to some degree.⁶ A recent meta-analysis concluded that lidocaine-prilocaine cream was the most effective medication for reducing pain at tenaculum placement and during IUD insertion.⁷ However, there is currently no consensus or standard management recommendation to reduce pain during IUD insertion. 10% lidocaine spray is a form of local anaesthesia that is convenient with minimal side effect, and it is used in several medical procedures, including obstetric and gynaecological procedures. Few studies have investigated the efficacy of 10% lidocaine spray for pain reduction during IUD insertion.^8–10 Pain score was evaluated in only some steps of the procedure, and the results differ among studies. The objective of this study was to investigate...