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For intrauterine device (IUD) insertion, the American College of Obstetricians and Gynecologists’ guidance recommends that clinicians offer local anesthetics such as lidocaine sprays, lidocaine-prilocaine creams, and paracervical blocks. Evidence on which approach produces clinically meaningful pain reduction — particularly among nulliparous patients — remains limited.
In a randomized trial, researchers assigned 370 nulliparous patients seeking smaller-diameter copper or levonorgestrel (13.5mg/19.5mg) IUDs to instillation with 10 ml of mepivacaine (20 mg/ml) or saline. Clinicians instilled assigned solutions via a hydrosonography catheter 2 minutes before placement. Pain was rated on a visual analog scale scored from 0 points (no pain…