Intracervical Anesthesia Does Not Relieve Pain During IUD Insertion

By Reuters Staff

NEW YORK - Intracervical anesthesia does not reduce the pain associated with insertion of levonorgestrel-releasing intrauterine devices (IUDs) in women without a previous vaginal delivery, researchers from Brazil report.

The fear of pain on the part of women and the difficulty of inserting the device, especially in nulliparous women and those with no previous vaginal deliveries, commonly limit the use of intrauterine contraceptives.

So far, no prophylactic pharmacological intervention has proven effective in relieving pain during or after insertion of intrauterine contraceptives.

In a randomized trial, Dr. Carol Sales Vieira from Medical School of Ribeirao Preto, University of Sao Paulo, Brazil and colleagues compared the effect of intracervical anesthesia to that of nonsteroidal anti-inflammatory drugs (which have been shown to be no better than placebo) on pain scores immediately following levonorgestrel IUD insertion in 96 women without a previous vaginal delivery who had not previously used any intrauterine contraception.

There were no differences between the two treatment groups in pain scores, the level of discomfort associated with insertion, or the difficulty of IUD insertion, the authors reported online September 19th in Human Reproduction.

About half of each group classified the insertion experience as slightly uncomfortable.

In multivariate analysis, being nulliparous was the variable most predictive of moderate/severe pain. Intracervical anesthesia reduced the risk of moderate/severe pain by 40%, but this difference was not statistically significant.

"Because nulliparous women presented a greater risk of pain and because the anesthetic reduced the risk of moderate/severe pain by 40%, assessments of only nulliparous or women with difficult insertions are required in future studies," the researchers say.

In the meantime, they conclude, "There is currently no evidence to recommend the routine use of prophylactic intracervical anesthesia prior to levonorgestrel (IUD) insertion; there is no evidence that this treatment reduces insertion-related pain."

Dr. Vieira did not respond to a request for comments.

SOURCE: https://bit.ly/1sRL8oA

Hum Reprod 2014.

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