Lidocaine-filled dilators may minimize pain during IUD removal

Infusing lidocaine into a disposable injectable cervical dilator helps reduce pain during the removal of an intrauterine device (IUD), especially when intrauterine manipulations are needed, according to a study.

Researchers conducted a double-blind, placebo-controlled, randomized clinical trial involving 74 women who were requesting outpatient IUD removal. These women were randomly assigned to receive either lidocaine (injecting 5 ml of 2% lidocaine into the injectable cervical dilator, n=37) or placebo (injecting 5 ml of normal saline into the device, n=37). All of them received a standardized paracervical block.

The primary outcome was pain during IUD removal, measured on a 100-mm visual analogue scale (VAS). Intention-to-treat analysis was performed to assess the analgesic effectiveness of injecting lidocaine into the injectable cervical dilators.

The median intraoperative VAS score was significantly lower in the lidocaine group than in the placebo group (30.0 vs 46.0 mm; p=0.01). Subgroup analyses showed no significant between-group difference in the intraoperative VAS score among participants undergoing IUD removal without uterine manipulation and additional procedures (15.0 vs 20.0 mm; p=0.28) and among those undergoing IUD removal with additional procedures (41.0 vs 45.0 mm; p=0.97).

However, among participants undergoing an IUD removal with intrauterine manipulations and without additional procedures, the lidocaine group had lower intraoperative VAS than the placebo group (25.0 vs 46.0 mm; p<0.01).