FPIN's Help Desk Answers
Local Anesthesia for IUD Insertion or Endometrial Biopsy
Am Fam Physician. 2017 Dec 1;96(11):online.
Is there a benefit to using local anesthesia for intrauterine device (IUD) insertion or endo-metrial biopsy?
Topical application of lidocaine/prilocaine cream to the cervix reduces mean pain scores during IUD insertion. Intrauterine instillation of liquid anesthesia reduces median pain scores during endometrial biopsy. (Strength of Recommendation: B, based on a single randomized controlled trial.)
A 2015 randomized, controlled, triple-blinded study of 46 Iranian women examined the effectiveness of lidocaine/prilocaine 5% cream (25 mg of lidocaine and 25 mg of prilocaine per g) applied to the cervix in reducing pain from copper IUD insertion or removal.1 Pain severity was assessed using a validated 10-cm visual analog scale after applying 5 g of cream to the cervix and external os with a cotton swab, then waiting seven minutes for anesthesia onset. Scores of 1 to 3, 4 to 6, 7 to 9, or 10 indicated mild, moderate, severe, and extremely severe pain, respectively. Pain severity during the first stage (tenaculum application) was significantly lower with lidocaine/prilocaine cream compared with placebo (mean pain scores of 1.5 vs. 4.3; P < .001). During the second stage (insertion of uterine sound), the mean pain score was also lower with lidocaine/prilocaine cream vs. placebo (3.1 vs. 5.2; P < .001). Similarly, the mean pain score during the last stage (insertion or removal of the IUD) was significantly lower with lidocaine/prilocaine cream vs. placebo (2.6 vs. 4.6; P < .001).
A randomized, double-blind, placebo-controlled trial in pre- and postmenopausal women compared pain levels during endometrial biopsy using local intrauter-ine anesthesia and placebo.2 Trial medications (0.9% saline for the control group vs. 0.5% levobupivacaine [no longer available in the United States] or 2% lidocaine for the experimental group) were identical in appearance and consistency. Technical variation was minimized by using a similar technique
1. Tavakolian S, Doulabi MA, Baghban AA, Mortazavi A, Ghorbani M. Lidocaine-prilocaine cream as analgesia for IUD insertion: a prospective, randomized, controlled, triple-blinded study. Glob J Health Sci. 2015;7(4):399–404.
2. Kosus N, Kosus A, Demircioglu RI, et al. Transcervical intrauterine levobupivacaine or lidocaine infusion for pain control during endometrial biopsy. Pain Res Manag. 2014;19(2):82–86.
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