Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen. The use of intrauterine lidocaine to minimize pain during hysterosalpingography: a randomized trial. Effect of prophylactic antibiotics on morbidity associated with IUD insertion: results of a pilot randomized controlled trial. IUD Study Group. [Prophylactic use of prostaglandin synthesis inhibitors in connection with IUD insertion]. Lidocaine spray and outpatient hysteroscopy: randomized placebo-controlled trial. Prevention of IUD-related pelvic infection: the efficacy of prophylactic doxycycline at IUD insertion. A double-blind randomized comparison of lidocaine and saline for cervical anesthesia. Randomized trial of lidocaine ointment versus placebo for the treatment of postpartum perineal pain. Naproxen sodium in uterine pain following intrauterine contraceptive device insertion.
This study was undertaken to determine whether 400 mg of prophylactic ibuprofen can alleviate pain from insertion of an intrauterine device (IUD) and to measure level of pain with improved techniques.
                We conducted a randomized, double-blind, placebo-controlled trial of 2019 first-time IUD users: 1008 women received placebo and 1011 women received 400 mg of ibuprofen. Participants took the single tablet at least 45 minutes before IUD insertion. Immediately after insertion, participants recorded level of pain by using a 10-cm visual analog scale, with the value of 10 meaning "worst imaginable pain."
                Median level of pain was 1.0 for both ibuprofen and placebo participants; rank test statistics confirmed no difference. Some subgroups of women experienced higher pain (eg, nulliparous women), but ibuprofen still had no important impact on level of pain.
                Even among first-time users, pain from IUD insertion is generally low. Prophylactic ibuprofen as used in this protocol does not reduce IUD insertion pain. A hysterosalpingogram is an integral part of the evaluation of infertility but is often painful. Intrauterine anesthesia may help to alleviate the discomfort associated with this procedure.
                We conducted a randomized, double-blinded, placebo-controlled trial of intrauterine lidocaine in women undergoing hysterosalpingography (HSG). All women were instructed to take a nonsteroidal analgesic before the hysterosalpingogram. Patients received 3 mL of buffered 2% lidocaine solution or 0.9% normal saline instilled into the uterus before HSG. The primary outcome was the degree of pain experienced documented via 10-cm visual analogue pain scales. Systematic assessments of discomfort were also collected by the attending physician, radiology technician, and radiology physician.
                Sixty-four patients were randomly assigned to placebo and 63 women were randomly assigned to the lidocaine group. There were no differences in mean age, race, parity, or history of dysmenorrhea or chronic pelvic pain. There were no differences in the pain scores at baseline, during, or after the study procedure between the 2 groups. Peak pain scale scores associated with the procedure were 5.3 +/- 0.4 in both the placebo and study groups. In addition, assessments of patient discomfort revealed no significant differences between the 2 groups.
                We found no difference in pain between the intrauterine-lidocaine and placebo groups. Intrauterine lidocaine does not appear to be effective in decreasing pain in women undergoing HSG.
                I The efficacy of administering an antibiotic prior to IUD insertion to reduce the risk of introducing an upper genital tract infection during the procedure has not yet been established. Two double-blind randomized studies conducted in Africa comparing a 200 mg prophylactic dose of doxycycline with a placebo did not conclusively identify a reduced risk of post-insertion pelvic inflammatory disease (PID). A clinical trial of comparable design is currently under way in the US. This multi-site trial will evaluate whether use of an antibiotic prior to insertion reduces the risk of IUD removal for all medical reasons, including upper genital tract infection, within the first three months after insertion. This paper reports on the pilot phase of this study, which was designed to test the protocols and data collection instruments in advance of the full-scale clinical trial. A total of 447 prospective IUD (TCu-380A) users were randomly assigned to receive either a 200 mg dose of doxycycline or a placebo one hour before IUD insertion. 3.6% (8/219) of participants who received the antibiotic had the device removed for medical reasons (infection, bleeding, cramping, etc.) within three months post-insertion compared to 4.5% (10/223) of participants who received the placebo. This reduction in the removal rate was not statistically significant given the limited size of the pilot study (RR = 0.81; 95% CI 0.28-2.29). Only two subjects, one from each treatment group, met the diagnostic criteria for acute PID. The overall three-month retention rate was 91.8% for the antibiotic group and 89.7% for the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS) In a double-blind, randomized, placebo-controlled study conducted at a contraception clinic, 55 women (three nulliparous) were given either ibuprofen 600 mg or placebo 1-4 hours prior to insertion of IUD, 4-6 hours after insertion of IUD and the following morning. Pain was assessed by ten point Numerical Rating Scales during insertion, in the first 4-6 hours and in the following three days. No benefit of ibuprofen was demonstrated at insertion or at any other time during the first three days. The patients were further randomized to type of IUD: TCu-380A and Nova T (R.). No difference in pain scores was evaluated between these. To assess the efficacy of lidocaine spray during outpatient hysteroscopy for reducing procedure-related pain and to identify risk factors for discomfort.
                One hundred twenty-one women were assigned randomly to have application of lidocaine spray or placebo to the uterine cervix during outpatient hysteroscopy. The main outcome measure was pain during hysteroscopy, assessed on a visual analog scale.
                There was no statistically significant difference between study and control groups in mean age, rate of nulliparity, postmenopausal state, need for cervical dilation, or percentage of women who used hormone replacement therapy. Indications for diagnostic hysteroscopy were similar between groups. Women in the lidocaine group had statistically significantly less pain during the procedure than women in the placebo group (2.2 +/- 1.9 and 3.7 +/- 2.5, respectively; P <.001). Women with abnormal uterine findings (submucous myoma, endometrial polyps, or intrauterine adhesions) had significantly higher pain scores than women with normal cavities (2.2 +/- 1.9 and 3.2 +/- 2.4, respectively; P <.002). Aerosol anesthesia and normal uterine findings were independently associated with less pain. No procedure had to be abandoned because of excessive pain or complications, and no women required hospitalization.
                Women treated with lidocaine spray had significantly less pain. Uterine cavity abnormality might be associated with a higher degree of pain during hysteroscopy. It is believed that much of the small increased risk for developing pelvic inflammatory disease (PID) associated with the use of an intrauterine device (IUD) appears to be caused by bacterial contamination of the endometrial cavity at the time of insertion. Previous research suggests that use of prophylactic antibiotics immediately prior to IUD insertion may reduce the risk of developing PID. This paper presents results from a randomized clinical trial of 1485 women in Ibadan, Nigeria evaluating the effectiveness of 200 mg of doxycycline (versus placebo) given orally at the time of IUD insertion in reducing the incidence of PID during the first three months of IUD use. Rate of PID infection in the doxycycline-treated group was not significantly lower than that in the placebo-treated group. The rate of unscheduled IUD-related visits to the clinic also was not significantly lower among the doxycycline-treated group. However, the incidence of PID was low (21 cases) for both study groups. Aseptic conditions during IUD insertion, follow-up visits with short intervals to monitor health, and treatment of opportunistic infections may have reduced the potential of PID within this population. To compare bacteriostatic saline and buffered lidocaine for cervical anesthesia to blunt the reported pain during brief suction curettage.
                A double-blind randomized clinical trial was conducted on women presenting for pregnancy termination procedures. Participants received either paracervical submucosal injections of bacteriostatic saline or 1% buffered lidocaine just before cervical dilation. Self-reported pain intensity was assessed at three time points during and 30 minutes after the procedure.
                Fifty-two of 135 eligible women presenting for pregnancy termination procedures participated in the study. Pain intensity ratings in lidocaine and saline treatment subjects did not differ significantly at any point. Our study had a power of 0.94 to detect more than a 15% difference on the 21-point box scale between the two solutions. Only one patient requested her block be repeated, and she had received lidocaine originally. Furthermore, of those women receiving lidocaine, 11% reported mild toxicity symptoms.
                To minimize lidocaine toxicity for a brief suction curettage procedure, bacteriostatic saline or very dilute lidocaine could be considered for the paracervical injection solution. The local anesthetic mechanism may be distention rather than blockage of specific autonomic nerves when there is no waiting period. This would mean that the term paracervical block could be changed to cervical anesthesia. To estimate the efficacy of lidocaine ointment in relieving pain after a vaginal delivery with an episiotomy or perineal laceration.
                In a randomized, double-blind, placebo-controlled trial, 200 women received lidocaine ointment (n = 108) or a placebo (n = 92). Pain relief was assessed by the amount of ointment used (weight of jar before use - weight of jar after use), total number of pain pills used, and a pain questionnaire. The sample size was calculated using a beta of.2 and an alpha of.05 with an expected reduction of other pain medications from an average use of six pills to four pills for the population.
                There was no significant difference in the amount of lidocaine versus placebo used for postpartum day 1 (5.1 g versus 4.0 g, respectively [P =.13]) or day 2 (3.7 g versus 2.6 g, respectively [P =.18]). Patients receiving lidocaine instead of the placebo showed no significant difference in the total amount of postpartum pain medications (6.3 versus 6.8 tablets, respectively [P =.53]), subjective pain parameters (P =.36), or satisfaction from ointment (P =.99). Patients with an episiotomy used more pain medications than those with a laceration (7.9 versus 5.6 tablets, respectively [P =.003]). Those with minor versus major lacerations required fewer pain pills (6.1 versus 10.8 tablets, respectively [P <.001]) and used less ointment (4.3 g versus 7.9 g, respectively [P =.02]) on the first postpartum day.
                Topical application of 5% lidocaine ointment was not effective in relieving episiotomy or perineal laceration pain. In a double-blind parallel trial, repeated doses of naproxen sodium (550 mg initially, followed by 275 mg every 6 hours as needed) and placebo were administered to a group of intrauterine contraceptive device (IUD) users in whom dysmenorrhea and premenstrual uterine pain developed or increased following the insertion of the IUD. Seventeen subjects were treated with naproxen sodium and 16 received placebo. The study covered three episodes of uterine pain and/or cramping. Efficacy of pain relief was judged by: (1) the overall relief which the patients experienced during the treatment and (2) the changes in the pain intensity (measured on a 6 point scale). By both these criteria, naproxen sodium was statistically significantly superior to placebo (p = 0.02); consequently, naproxen sodium appears to offer a new treatment modality for pain associated with IUD usage.
No interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation.