Dysmenorrhoea as a risk factor for pain with intrauterine device insertion

Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial

BACKGROUND

Fear of pain associated with intrauterine device (IUD) placement has been identified as a significant barrier to the adoption of long-acting reversible contraception, contributing to lower utilization of the most effective reversible contraceptive methods.

OBJECTIVE

To assess whether instillation of intrauterine mepivacaine before IUD placement alleviates pain more effectively than a placebo.

STUDY DESIGN

We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving nulliparous women undergoing IUD placement. An intrauterine instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride was administrated through a hydrosonography catheter 2 minutes prior to IUD placement. Pain scores were assessed using a 100 mm visual analog scale (VAS) at prespecified time points. Primary outcome measured the difference in VAS pain scores between the intervention group and the placebo group during IUD placement. Secondary outcomes included VAS pain scores at instillation and 10 minutes after placement, tolerability of the placement pain, as well as acceptability of the analgesia method.

RESULTS

We enrolled 151 participants, with 76 assigned to the mepivacaine group and 75 to the placebo group. The mean VAS pain score during IUD placement showed a difference of 13.3 mm (95% confidence interval (CI) 5.75-20.87; P<.001): the mepivacaine group had a mean of 53.9 mm (standard deviation [SD] 22.8), while the placebo group had a mean of 67.2 mm (SD 22.4). After adjusting for each individual provider's impact, the difference in mean pain scores remained statistically significant (12.2 mm 95% CI 4.85-19.62; P<.001). A greater proportion of women in the intervention group reported tolerable pain during placement with 70/75 participants (93.3%) compared to 53/66 participants (80.3%) in the placebo group (P=.021).

CONCLUSION

The intrauterine instillation of mepivacaine results in statistically significant reduction in pain score among nulliparous women during IUD placement. Although the precise clinical impact of this pain reduction method remains uncertain, the observed reduction in pain score result in a higher proportion of women reporting tolerable pain. This finding and the high acceptance as a pain reduction method thereby suggests clinical relevance. Intrauterine instillation of mepivacaine is a possible strategy to increase IUD utilization, particularly among nulliparous women who are at high risk of unintended pregnancy.

Analgesic effects of LI4 acupuncture during intrauterine device insertion: a randomized controlled clinical trial

PURPOSE

Intrauterine device (IUD) is one the most effective contraceptive methods with reversible long-term effects. However, the major drawback of IUD use is pain perception during the insertion of the device. The aim of this study is to investigate the effects of bilateral LI4 acupuncture, administered before IUD insertion, on pain perception.

METHODS

This is a prospective randomized controlled study. It was held in Community Health Center in Niğde, Turkiye. Individuals enrolled in the study were randomized into the acupuncture group and non-intervention group. Acupuncture group received bilateral LI4 acupuncture prior to IUD insertion while others received no interventions. After IUD insertion, 10 cm visual analog scale (VAS) score was evaluated at 3rd minute and at 10th minute. Health care provider performing the IUD insertion and VAS evaluation was blind to randomization.

RESULTS

In total 72 participants were included in the study. The VAS scores were significantly lower in the acupuncture group both at 3rd minute and at 10th minute (1.93 ± 1.68; 3.81 ± 1.95; p < 0.001 and 0.53 ± 0.84; 1.64 ± 1.10; p < 0.001 respectively). Linear regression analysis showed that acupuncture was a significant predictor for lowering VAS both at 3rd minutes and 10th minutes following IUD insertion (p < 0.001).

CONCLUSION

This is the first randomized controlled clinical study investigating the effects of acupuncture on pain control during IUD insertion. The results demonstrated that bilateral LI4 acupuncture provides significant pain relief at both cervical and fundal components. Acupuncture prior to IUD insertion is a significant predictor of lowering overall VAS scores of individuals.

TRIAL REGISTRATION

NCT04963582.