The Use of Lidocaine Spray and Paracervical Nerve Block in Pain Management During Intrauterine Device Insertion: A Literature Review
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Date
2024-05-15
Authors
Plowman, Raelynn
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Abstract
Introduction: An intrauterine device (IUD) is an extremely reliable form of contraception with
one of the highest satisfaction rates among users. Yet, in Canada the use of IUDs as primary
contraception remains low. Women report that pain during IUD insertion dissuades them from
selecting this form of contraception. Despite evidence that women experience discomfort during
IUD insertions, standard pain control options remain unavailable.
Objective: This literature review aims to evaluate the evidence for lidocaine spray and lidocaine
paracervical nerve block in the management of pain during IUD insertion. A second objective is
to assess if these techniques are suitable for outpatient visits.
Methods: A search on PubMed was performed with key words and inclusion criteria to obtain
articles pertaining to the use of both topical and injected lidocaine as pain management
techniques during IUD insertion.
Results: Three studies explored the benefits of lidocaine spray during IUD insertion and two
studies assessed the effects of a lidocaine paracervical nerve block. Not only were both topical
and injected forms of lidocaine effective in reducing pain during IUD insertion, these techniques
were also effective in reducing pain during other procedural steps. Additionally, all participants
in the studies tolerated the procedure well on an outpatient basis.
Conclusion: Two effective pain management techniques have been identified in the literature.
Lidocaine spray was found to be effective in reducing pain in parous women during multiple
steps of IUD insertion. While a paracervical block was effective in reducing pain during IUD
insertion in nulliparous women. Further, these interventions were tolerated well and suitable for
outpatient clinics.