Reduced pain during IUD placement found when using mepivacaine
A new study finds that intrauterine instillation of 2% mepivacaine significantly lowers pain levels during intrauterine device placement.
Reduced pain during IUD placement found when using mepivacaine | Image Credit: © Mariakray - © Mariakray - stock.adobe.com.
During intrauterine device (IUD) placement, nulliparous women experience a significant reduction in pain when utilizing intrauterine instillation of mepivacaine, according to a recent study published in the American Journal of Obstetrics & Gynecology.1
Long-acting reversible contraception (LARC) remain the most effective reversible options, with many guidelines recommending these methods. However, LARC methods remain underutilized compared to short-acting contraception.2
Fear of pain has been cited as a common barrier toward IUD placement among nulliparous women.1 This indicates the need for an easily available pharmacological intervention to reduce pain during IUD placement. Mepivacaine has been indicated as an effective intervention for pain reduction, but additional data is needed.
To determine the efficacy of mepivacaine for pain reduction during IUD placement in nulliparous women, investigators conducted a multicenter, double-blind, randomized placebo-controlled trial. Participants included nulliparous women aged 18 to 31 years opting for a 52-mg levonorgestrel hormonal IUD as their method of contraception.
Patients with current IUD use, prior conization, cervical stenosis diagnosis, body weight under 40 kg, signs of ongoing genital infection, uterine abnormality, or certain medical conditions were excluded from the analysis. Participating providers included midwives and gynecologists well versed in IUD placement.
The current pain and worst menstrual cramping during typical menstruation of participants were measured on a 100-mm visual analog scale (VAS), with a higher score indicating increased pain. Patients were randomized 1:1 to receive either 10 mL of 20-mg/mL mepivacaine or 10 mL of 9-mg/mL sodium chloride. The latter was considered placebo.
Standardized protocol was used for IUD placement. Pain scores on VAS were assessed to determine the efficacy of the intervention compared to placebo. VAS scores were recorded at baseline, shortly after intrauterine instillation, IUD placement, and 10 minutes after speculum removal.
At 10 minutes after speculum removal, participants rated their overall procedure experience. Options included “easier than expected,” “as expected,” and “worse than expected.” Safety was determined based on the presence of adverse events such as vasovagal reactions, allergic reaction, failed placements, and side effects.
There were 141 participants in the intention-to-treat (ITT) analysis and 124 in the per the protocol (PP) analysis. Demographic characteristics did not significantly differ between groups, and the mean VAS score during the most intense cramping during menstruation was 50.7 mm in the mepivacaine group vs 55.1 mm in the placebo group.
The mepivacaine group had a reduced mean VAS pain score during IUD placement compared to the placebo group in the ITT analysis, at 53.9 mm vs 67.2 mm, respectively. This indicated an absolute difference of 13.3 mm. A mean reduction in the VAS pain score of 12.2 mm was reported for the intervention.
In the PP analysis, the mean pain scores decreased by 54.5 mm and 68.8 mm in the mepivacaine and placebo groups, respectively. This indicated a mean pain reduction of 12.3 mm.
There were no significant differences in the VAS pain scores or the need for additional medication between groups at 10 minutes after placement. Additionally, no serious adverse effects were linked to mepivacaine treatment.
These results indicated reduced pain during IUD placement through instillation of 2% mepivacaine. Investigators concluded instillation of mepivacaine may reduce barriers to IUD uptake.
References
- Envall N, Elgemark K, Kopp Kallner H. Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial. American Journal of Obstetrics & Gynecology. 2024;231(5):524.E1-524.E7. doi:10.1016/j.ajog.2024.05.038
- Hellström A, Gemzell Danielsson K, Kopp Kallner H. Trends in use and attitudes towards contraception in Sweden: results of a nationwide survey. Eur J Contracept Reprod Health Care. 2019;24(2):154-160. doi:10.1080/13625187.2019.1581163
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