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Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial

Mody, Sheila K., MD, MPH; Farala, John Paul, MD; Jimenez, Berenice, MD; Nishikawa, Moena; Ngo, Lynn L., MD, MPH

doi: 10.1097/AOG.0000000000002790
Contraception: Original Research: PDF Only

OBJECTIVE: To investigate whether a 20-cc buffered 1% lidocaine paracervical block decreases pain during intrauterine device (IUD) placement.

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

RESULTS: 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). There were no differences in baseline demographics between the groups. Women who received the paracervical block reported less pain with IUD placement compared with women who received no block (median visual analog scale score of 33 mm vs 54 mm, P=.002). 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). Participants who received the paracervical block experienced more pain with block administration compared with placebo (30 mm vs 8 mm, P=.003). 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).

CONCLUSION: A 20-cc buffered 1% lidocaine paracervical block decreases pain with IUD placement (primary outcome), uterine sounding (secondary outcome), and 5 minutes after placement (secondary outcome). Although paracervical block administration can be painful, perception of pain for overall IUD placement procedure is lower compared with no block.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02219308.

Paracervical block decreases pain with intrauterine device placement among nulliparous women.

Division of Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, and Southern California Permanente Medical Group, San Diego, California.

Corresponding author: Sheila K. Mody, MD, MPH, Division of Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, 9300 Campus Point Drive, MC 743, La Jolla, CA 92037; email: smody@ucsd.edu.

Dr. Mody was partially funded by National Institutes of Health grant K12 HD001259.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank the clinic staff at University of California, San Diego and Planned Parenthood of the Pacific Southwest for collaborating on this study.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received March 26, 2018

Received in revised form May 18, 2018

Accepted June 07, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.