Mody SK, et al. - Authors gauged if pain during intrauterine device (IUD) placement is decreased with a 20-mL buffered 1% lidocaine paracervical block among nulliparous women. A decrease in pain was seen with a 20-mL buffered 1% lidocaine paracervical block with IUD placement (primary outcome), uterine sounding (secondary outcome), and 5 minutes after placement (secondary outcome). Paracervical block administration can be painful, however, compared with no block, perception of pain for overall IUD placement procedure is lower.

Methods

• Authors assigned the women to receive either a 20-mL buffered 1% lidocaine paracervical block or no block before IUD placement in a randomized, single-blind, placebo-controlled trial.
• Pain with IUD placement measured on a 100-mm visual analog scale was the primary outcome.
• In visual analog scale scores, this sample size had 80% power (α=0.05) to detect a 20-mm difference with a SD of 28 mm.
• Pain with speculum placement, paracervical block administration, tenaculum placement, 5 minutes postprocedure, and overall pain perception were included in the secondary outcomes.

Results

• As per data, from October 7, 2014, through October 26, 2017, 64 women were enrolled and analyzed (33 in the paracervical block arm, 31 in the no-block arm).
• Between the groups, no differences in baseline demographics were seen.
• Less pain with IUD placement was reported by the women who received the paracervical block compared with women who received no block (median visual analog scale score of 33 mm vs 54 mm, P=.002).
• Findings suggested that pain was significantly less in the intervention group for uterine sounding (30 mm vs 47 mm,P=.005), 5 minutes after placement (12 mm vs 27 mm,P=.005), and overall pain perception (30 mm vs 51 mm,P=.015).
• More pain was experienced by the participants who received the paracervical block with block administration compared with placebo (30 mm vs 8 mm,P=.003).
• Results demonstrated that there was no perceived pain difference for speculum insertion (10 mm vs 6 mm,P=.447) or tenaculum placement (15 mm vs 10 mm,P=.268).