Intrauterine Mepivacaine Instillation vs Placebo for Pain During IUD Placement: A Randomized Clinical Trial.
Karin Elgemark, Niklas Envall, Helena Kopp Kallner
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In 30 seconds
This multicentre, double-blind, randomised, placebo-controlled trial tested intrauterine mepivacaine before IUD placement in nulliparous individuals aged 18 to 31 years at 11 Swedish clinics. Among 370 randomised participants, mean pain during placement was 43.8 mm with mepivacaine and 58.6 mm with saline; the mean difference was 14.8 mm (95% CI, 10.0-19.6; P < .001). Tolerable pain was also more frequently reported with mepivacaine. The findings support a reduction in procedural pain and improved tolerability in the studied population.
Key findings
- Mean placement pain was 43.8 mm with mepivacaine versus 58.6 mm with placebo; mean difference, 14.8 mm (95% CI, 10.0-19.6; P < .001).
- Tolerable pain was reported by 172 of 175 participants (98.3%) with mepivacaine and 159 of 174 (91.4%) with placebo (NNT, 15 [95% CI, 9-43]).
- Adjustment for individual clinician yielded a similar mean pain difference of 14.2 mm (95% CI, 9.7-18.6; P < .001).
Why it matters
Pain during IUD placement can affect contraceptive choice and the procedural experience. In this randomised trial, intrauterine mepivacaine reduced reported pain and increased the proportion reporting tolerable pain, providing evidence that a local anaesthetic approach may improve the placement experience for nulliparous individuals choosing the studied IUDs.
What to keep in mind
The findings apply to nulliparous individuals aged 18 to 31 years choosing IUDs with smaller-diameter placement tubes at Swedish outpatient clinics; applicability to other populations and devices is not established by this trial.