Intrauterine mepivacaine reduced pain during intrauterine device placement by 13.3 mm on a 100-mm pain scale, with 93.3% of women reporting tolerable pain compared with 80.3% with placebo, according to a recent study.

In the multicenter, double-blind, randomized controlled trial, published in the American Journal of Obstetrics & Gynecology, researchers evaluated the efficacy of intrauterine mepivacaine instillation for pain reduction during intrauterine device (IUD) placement in nulliparous women. The researchers randomly assigned 151 participants aged 18 to 31 years to receive 10 mL of 2% mepivacaine (n = 76) or placebo (n = 75) via hydrosonography catheter 2 minutes prior to IUD placement. Pain was measured using a 100-mm visual analog scale (VAS).

The primary outcome demonstrated a significant reduction in mean VAS pain scores during placement in the mepivacaine group (53.9 mm, standard deviation [SD] = 22.8) compared with the placebo group (67.2 mm, SD = 22.4), with an absolute difference of 13.3 mm (95% confidence interval [CI] = 5.75–20.87, P < .001). After adjusting for provider effects, the reduction remained statistically significant at 12.2 mm (95% CI = 4.85–19.62, P < .001).

Secondary outcomes showed that 93.3% of the participants in the mepivacaine group reported tolerable pain during placement compared with 80.3% in the placebo group (P = .02). Additionally, 77.0% of the participants in the mepivacaine group would recommend the analgesic method to others compared with 60.9% in the placebo group (P = .04). A higher proportion of participants in the mepivacaine group described the procedure as easier than expected compared with the placebo group (40.5% vs 25.0%, P = .04).

No serious adverse events were observed, and instillation pain was minimal in both groups. The findings indicated that intrauterine mepivacaine significantly reduced pain during IUD placement in nulliparous women. 

Further research is warranted to evaluate the intervention’s applicability across different IUD types and among less experienced providers. 

Full disclosures can be found in the published study.