Effect of Lidocaine Spray in Pain Management during IUCD Insertion: A Randomized Controlled Trial

Abstract

Summary I ncreasing the number of women using IUCDs is an important public health goal. Fear of pain during IUCD insertion is one reason women may not want to use this highly effective birth control method. Pain at insertion of an IUCD can be distressing and may push women away from using this method. Determining an optimal method for reducing pain during IUCD insertion will benefit women and may increase the uptake of IUCDs as a contraceptive method. The levels of pain that women experience during IUCD insertion vary in published reports. Most women experience mild to moderate discomfort during IUCD insertion. Rarely, the pain is severe and associated with nausea and weakness. Pain may persist for a few days after insertion. Prophylactic NSAIDs, as studied, do not appear to reduce pain during IUCD insertion, or four to six hours after IUCD insertion. Benefit may occur in the first couple hours after IUCD insertion in nulliparous women given naproxen, however. The use of misoprostol to prime the cervix in addition to diclofenac before IUCD insertion in nulliparous women did not appear to reduce pain and may increase side effects. No serious harms were reported in these trials, although such reporting was incomplete. Evaluation of pain as a symptom is difficult because it is subjective feeling and composed of sensory, emotional, and cognitive components. Pain tolerance is deeply influenced by culture. A Visual Analogue Scale (VAS) is a measurement instrument that tries to measure a characteristic or attitude that is believed to range across a continuum of values and can not easily be directly measured. This validated pain scale uses a 10 cm line to represent the continuum of ‘no pain’ to ‘worst imaginable pain’. The current study was conducted at Ain Shams University Maternity Hospital at family planning clinic during the period between September 2015 to March 2016. A total of 170 women sought family planning through IUCD insertion were included in the study divided into 2 groups; group I (85 women received Lidocaine spray 10% topically to the cervix) and group II (85 women received normal saline placebo topically to the cervix). There was no significant difference between the two groups regarding age, parity, BMI, interval from last pregnancy, interval from last breast feeding, previous contraceptive methods and anticipated pain, denoting that both groups were matched regarding factors that may influence pain sensation during the process of IUCD insertion. The two groups then were compared regarding pain felt during cervical traction after application of tenaculum, IUCD insertion and pain felt after insertion using VAS score to detect the efficacy of the tested drug on decreasing pain sensation. In this study results founded that, the P value for age is 0.900 which is statistically insignificant. Also, as regard parity, the P value was 0.267 which is statistically insignificant.as regard BMI, the P value was 0.847 which is statistically insignificant. As regard time interval from last pregnancy, the P value was 0.422 which is statistically insignificant. As regard lactation period, P value was 0.701 which is statistically insignificant. Regarding previous contraception methods, P value for IUD was 0.758, for pills was 0.798 which is statistically insignificant for both. As regard predicted pain, P value was 0.350 which is statistically insignificant. Regarding pain from traction, P value was <0.001 which is statistically significant.as regard pain from insertion, P value was 0.013 which is statistically significant.as regard pain after insertion, P value was 0.011 which is statistically significant. Results proved that application of lidocaine spray 10% to the cervix few minutes prior to IUCD insertion is a practical and effective way to decrease the pain associated with this process.