The efficacy of lidocaine spray on Pain perception during IUD insertion. A Randomized Controlled Trial

Abstract

Increasing 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 deter women from using the 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. 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. The current study was conducted at Ain Shams University Maternity Hospital at family planning clinic during the period between March 2015 and December 2015. A total of 120 women sought family planning through IUCD insertion were included in the study divided into 3 groups; group 1 received 20 mg lidocaine spray 10% topically to the cervix uteri , group 2 received 10 mg lidocaine spray 10% and group 3 received normal sterile saline topically to the cervix.

There was no significant difference between the three groups regarding age, parity, interval from LMP, dysmenorrhea, history of previous IUCD insertion and pain expectancy. Denoting that both groups were matched regarding factors that may influence pain sensation during the process of IUCD insertion. The three groups then were compared regarding pain felt during cervical traction, during IUCD insertion and after IUCD insertion (5-10 min later) using VAS score to detect the efficacy of the tested drug on decreasing pain sensation. Regarding pain felt during cervical grasping and traction (measured by VAS), the median in group1 was 4 and the interquartilerange was from 3 to 5. In group 2 the median was 2 and the interquartile range was from 2 to 4. In group 3 the median was 1 and the interquartile range was from 1 to 2. On comparing the 3 groups, the P value was less than 0.0001 which is statistically significant. P value was more statistically significant in case of 20-mg lidocaine group compared to 10-mg lidocaine group (using conover test). Regarding pain felt during IUCD insertion (measured by VAS), the median in group1 was 3 and the interquartile range was from 2 to 5. In group 2 the median was 2 and the interquartile range was from 1 to 3. In group 3 the median was 1 and the interquartile range was from 1 to 2. The P value was less than 0.0001 which is statistically significant. P value was more statistically significant in case of 20-mg lidocaine group compared to 10-mg lidocaine group (using conover test). Regarding pain felt during IUCD insertion (measured by VAS), the median in group1 was 2 and the interquartile range was from 1 to 4. In group 2 the median was 1 and the interquartile range was from 1 to 2. In group 3 the median was 0 and the interquartile range was from 0 to 1. The P value was less than 0.0001 which is statistically significant. P value was more statistically significant in case of 20-mg lidocaine group compared to 10-mg lidocaine group (using Conover test). Results proved that lidocaine spray 10% application to the cervix during IUCD insertion effectively reduce pain felt during this process and the 20mg dose was more effective in decreasing pain than 10mg dose.