EFFECT OF LIDOCAINE GEL ON PAIN FROM COPPER IUD INSERTION: A RANDOMIZED DOBELL BLIND CONTROLLED TRIAL

The copper bearing intrauterine device (IUD) is a long-term, reversible contraception method that is as effective as tubal sterilization. Its insertion pain or fear of it may make women hesitate to use an IUD. This study aimed to determine the effect of lidocaine gel on pain from copper IUD insertion. This study was done among 96 women at a health center in Tabriz. The subjects were allocated into three groups using random blocking with 6 and 9 block sizes considering allocation concealment. Inone group, lidocaine 2% gel and in the second, lubricant gel was placed in the cervical canal by a sterile swab one minute before IUD insertion and the third group got no intervention. IUD inserter was blind for the gels used and subjects and the pain assessor were blind for intervention. One expert midwife inserted all the IUDs. Immediately after IUD insertion, pain during the insertion was measured using 0-10 cm visual analogue scale, with the value of 10 meaning ‘‘worst imaginable pain.’’One way ANOVA, Kruskal-Wallis, unpaired t-test, Mann-Whitney and linear regression in SPSS-13 were used to identify effect of lidocaine gel on the pain. Overall, the mean pain score was 3.5±1.8. In univariate analysis, there was no significant difference in pain scores between three groups. Comparison of frequencies and univariate analysis showed difference in some possible confounding factors between the groups. Results of linear regression model by controlling effect of the possible confounding factors including history of vaginal delivery, interval from the last delivery, situation of lactation, history of IUD insertion and the interval of cervix wash and pain assessment showed no significant effect of lidocaine gel on the insertion pain. The mean pain score in the lidocaine group was 0.39 less than in the control group but it was no significant (CI 95% of the difference: -1.3, 0.57). Use of 2% lidocaine gel and also use of lubricant gel into the cervical canal, one minute before putting on cervical tenaculum, has no effect on reducing overall pain during IUD insertion.