Letters to the Editor

Lidocaine for Pain Control During IUD Placement

 


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Am Fam Physician. 2014 Nov 1;90(9):612.

Original article: Intrauterine Devices: An Update

Issue date: March 15, 2014

Available at: http://www.aafp.org/afp/2014/0315/p445.html

to the editor: We were pleased to see Hardeman and Weiss' recent update on intrauterine devices (IUDs).1 They addressed many common misconceptions about IUDs, including use in adolescents, in patients who are nulliparous, and in patients with a history of sexually transmitted infection. The authors did not mention use of lidocaine during IUD insertion, either topically or via cervical block. Cervical lidocaine has been used for pain control for multiple outpatient gynecologic procedures, including colposcopy, endometrial biopsy, hysteroscopy, and cervical dilation and aspiration.2 Although the available evidence is somewhat mixed, the risk of harm is low, with a primary risk of pain, bleeding, and vasovagal symptoms with injected lidocaine.3

Multiple trials have evaluated the use of topical lidocaine in a gel or spray formulation to decrease pain from the injection and from the procedure itself. These formulations may be less readily available and seem to have less effect on decreasing pain.4

Lidocaine can be injected into the anterior lip of the cervix to decrease pain with tenaculum placement.5 An alternative option is to inject lidocaine into the cervix at the 3- and 9-o'clock positions where the nerve bundles that innervate the cervix are located.6 For other outpatient gynecologic procedures, multiple other sites of the cervix have been injected for anesthesia, including the 4- and 8-o'clock positions or the 2-, 4-, 8-, and 10-o'clock positions.2

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Hardeman J, Weiss BD. Intrauterine devices: an update. Am Fam Physician. 2014;89(6):445–450....

2. Allen RH, Micks E, Edelman A. Pain relief for obstetric and gynecologic ambulatory procedures. Obstet Gynecol Clin North Am. 2013;40(4):625–645.

3. Mody SK, Kiley J, Rademaker A, Gawron L, Stika C, Hammond C. Pain control for intrauterine device insertion: a randomized trial of 1% lidocaine paracervical block. Contraception. 2012;86(6):704–709.

4. McNicholas CP, Madden T, Zhao Q, Secura G, Allsworth JE, Peipert JF. Cervical lidocaine for IUD insertional pain: a randomized controlled trial. Am J Obstet Gynecol. 2012;207(5):384.e1–6.

5. Robinson RD, Casablanca Y, Pagano KE, Arthur NA, Bates GW, Propst AM. Intracervical block and pain perception during the performance of a hysterosalpingogram: a randomized controlled trial. Obstet Gynecol. 2007;109(1):89–93.

6. Cirik DA, Taskin EA, Tuglu A, Ortaç AS, Dai O. Paracervical block with 1% lidocaine for pain control during intrauterine device insertion: a prospective, single-blinded, controlled study. Int J Reprod Contracept Obstet Gynecol. 2013;2(3):263–267.

in reply: We would like to thank Drs. Pippitt and Gunning for their comments regarding our article. Because a prior article in American Family Physician had thoroughly reviewed IUD insertion techniques,1 this was not the primary focus of our article. However, we appreciate the information they have shared about methods for decreasing pain from IUD placement.

Author disclosure: No relevant financial affiliations.

REFERENCE

1. Johnson BA. Insertion and removal of intrauterine devices. Am Fam Physician. 2005;71(1):95–102.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



 

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