Paracervical Block for Intrauterine Device Placement among Class II Obese Women: A Single-Blinded Randomized

Document Type : Original Article

Authors

1 Obstetrics and gynecology department, faculty of medicine, Ain shams university

2 Department of Obstetrics and Gynecology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt

Abstract

Background: The intrauterine contraceptive device (IUCD) is the most widely used reversible contraceptive, with around 120 million users worldwide. Its popularity stems from its high efficacy, reversibility, and proven safety. However, pain during insertion can limit its use, particularly among obese women. To address this, both non-pharmacologic and pharmacologic pain management strategies are employed, with paracervical block being a common technique that is regarded as both safe and easy to perform during IUCD insertion.
Aim: To assess the effectiveness of paracervical block for management of pain during IUCD insertion in class II obese women..
Materials and Methods: A prospective randomized controlled trial was conducted at the family planning clinic, Obstetrics and Gynecology department of Ain Shams hospitals during the period from 1/1/2024 to 31/12/2024. A total of 140 women undergoing IUCD insertion were divided into two groups: Group A (non-intervention group): Includes 70 women who didn’t receive and local anethesia. Group B (intervention group): Includes 70 women who received paracervical block before IUCD insertion.
Results: The demographic characteristics of participants in both groups were comparable, Women who received the paracervical block reported less pain with IUCD insertion compared to women who received no block (median VAS: 3 vs. 5, p<0.0001), they also experienced less pain during vulsellum application (median VAS: 1 vs. 2, p<0.0001), uterine sounding (median VAS: 2.5 vs. 3, p<0.0001) and five minutes post-insertion (median VAS: 1 vs. 3, p<0.0001) which is statistically significant, However, there was no statistically significant perceived pain difference during specu-lum insertion (median VAS: 4 vs. 3, p=0.3248).
Conclusion: 20 ml lidocaine 1% paracervical block significantly decreased perceived pain during IUCD insertion compared to no intervention.

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