A Swedish clinical trial published in JAMA reveals that administering 2% intrauterine mepivacaine via a catheter significantly reduces pain during IUD insertion. Among 370 nulliparous women, those receiving the anesthetic reported a mean pain score of 43.8 on a 100-point scale, compared to 58.6 for the placebo group, with 98.3% finding the pain tolerable. This needle-free method offers a simple outpatient alternative amid rising patient demands and updated CDC guidance urging better clinical management of IUD insertion pain.
Intrauterine mepivacaine trial results
- ▪A Swedish randomized controlled trial published in JAMA found that intrauterine instillation of 2% mepivacaine significantly reduced pain during intrauterine device (IUD) insertion compared to a placebo.
- ▪Patients in the Swedish clinical trial received either 10 mL of 2% mepivacaine or a sodium chloride placebo administered via a hydrosonography catheter two minutes before IUD placement.
- ▪The Swedish clinical trial evaluated 370 nulliparous patients aged 18 to 31 across 11 outpatient clinics in Sweden from May 2021 to June 2024.
- ▪In the Swedish clinical trial, the mean pain score during IUD placement was 43.8 mm on a 0-to-100 visual analog scale for the mepivacaine group compared to 58.6 mm for the placebo group.
Patient reports of IUD pain
- ▪Patients have increasingly reported experiencing pain during intrauterine device (IUD) insertions in recent years, including sharing their experiences on social media.
- ▪A study published in JAMA found that one in five patients who were universally offered intravenous moderate sedation for IUD insertion chose to receive it.
Pain management method comparison
- ▪Dr. Nikki Zite noted that intrauterine mepivacaine instillation would have no impact on pain caused by speculum or tenaculum placement during the IUD insertion procedure.
- ▪The Swedish clinical trial did not compare the efficacy of intrauterine mepivacaine instillation against other active pain relief methods, such as lidocaine gel or paracervical blocks.
Clinical guidance on IUD insertion
- ▪The American College of Obstetricians and Gynecologists has called for clinicians to discuss pain management options with patients before performing IUD insertions.
- ▪The U.S. Centers for Disease Control and Prevention (CDC) has urged physicians to counsel patients about the potential pain associated with IUD placement.
Patient tolerability and satisfaction
- ▪More than half of the patients in the mepivacaine group found the IUD insertion procedure easier than expected, compared to approximately one-third of the placebo group.
- ▪In the Swedish clinical trial, 98.3% of patients in the mepivacaine group reported their pain during IUD insertion was tolerable compared to 91.4% in the placebo group.
- ▪In the Swedish clinical trial, 79% of patients who received intrauterine mepivacaine said they would recommend the pain relief method to others, compared to 68.6% of the placebo group.
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