NEW YORK (Reuters Health) – Lidocaine paracervical nerve block reduces pain during intrauterine device (IUD) insertion in adolescents and young women, according to results from a randomized sham-controlled trial.
“These findings identify a subgroup of women, specifically adolescent and young adult women, for whom providing a paracervical nerve block can reduce the pain that patients report during IUD insertion,” lead author Dr. Aletha Y. Akers of Children’s Hospital of Philadelphia, told Reuters Health by phone.
“Most prior research conducted in adult women has not shown paracervical nerve block to be helpful. However, not only may this nerve block make the procedure more comfortable for these younger patients, but fear of pain during insertion is a barrier to IUD uptake. So this may improve uptake among patients who are at the highest risk for unintended pregnancy,” she added.
Dr. Akers and her colleagues randomized 95 English-speaking nulliparous, non-pregnant females ages 14 to 22 to receive either 10-mL 1% lidocaine paracervical nerve block or sham block (1 cm depression of vaginal epithelium at paracervical block sites with a wooden cotton-tipped applicator) 3 minutes before insertion of a 13.5-mg levonorgestrel IUD. The patients were blinded to the instruments and supplies being used, but the researchers were not.
Participants were recruited from three urban family planning clinics in Philadelphia; close to half were white, 36% were black, 96% had health insurance (65% with a private insurer), and 79% had previously used hormonal contraception.
The study was published in Obstretics and Gynecology, online September 7.
Both groups received 800 mg of oral ibuprofen at least 20 minutes before the procedure to reduce postprocedural pain.
On a 100-mm visual analog scale ranging from no pain (0 mm) to worst pain in my life (100 mm), the median pain score was significantly lower in the lidocaine nerve-block group than in the sham group (30.0 mm vs. 71.5 mm). However, the two groups did not differ significantly in their overall satisfaction with the insertion procedure.
“I was not surprised,” Dr. Akers said. “Even though prior work had not shown that this particular pain-reduction approach was effective in adult women, adolescent and younger adult women are different from older women in many ways. My clinical suspicion that these younger women would benefit from the lidocaine block was based on my experiences in clinical practice.”
“Many of our approaches to caring for adolescent and young adult women are borrowed from the ways we treat older adult women,” she added. “Providers need to think about the unique needs of these younger patients so we can improve their care.”
“Some important questions remain unanswered. For example, our study not only found that the paracervical nerve block reduced pain, but it also suggested that women still experienced pain with placement of the speculum, which suggests that they may benefit from some additional pain-control measures,” Dr. Akers said.
Coauthor Dr. Sarita Sonalkar of the Hospital of the University of Pennsylvania in Philadelphia noted, “Paracervical blocks have been shown to be effective for other gynecologic procedures, and my patients always seemed more comfortable with IUD insertions when I used paracervical blocks,” she said.
“I hope providers will change their practice to incorporate paracervical blocks for IUD insertions. It is important for the larger gynecology community to know that effective mechanisms exist to improve pain during procedures. Women may be more likely to choose IUDs if they understand that an intervention to improve pain during the procedure is available,” Dr. Sonalkar noted.
Among the study limitations are use of the smallest IUD available and the increased likelihood of nulliparous women to feel pain during IUD insertion. Also, participants tended to be white, insured, educated and urban – and to have low IUD-use rates. The investigators are planning further research to explore unanswered questions, Dr. Akers said.
The authors advise providers to carefully consider the risks associated with paracervical nerve blockade, including potential side effects and higher costs.
Bayer HealthCare Pharmaceuticals Inc. and the Health Services Research Administration supported the study.
SOURCE: http://bit.ly/1RH7gvL
Obstet Gynecol 2017.
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