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Intrauterine lidocaine significantly reduces pain during IUD insertion in nulliparous and parous womenLidocaine may reduce pain during IUD insertion for women

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Key Takeaway
Consider lidocaine as a low-risk strategy to reduce pain during IUD insertion, particularly in nulliparous women.

This meta-analysis evaluated the efficacy of intrauterine anesthesia (IUA) for pain management during IUD insertion in a sample of 651 nulliparous and parous women. The analysis found that IUA significantly reduced pain during insertion compared to a normal saline infusion (SMD -0.47, 95% CI -0.90 to -0.03; p = 0.04).

Subgroup analyses revealed that lidocaine specifically provided a significant reduction in pain (n=262, p = 0.0002). In contrast, other anesthetic agents (n=165) did not show a significant effect (p = 0.27). Pain levels after insertion did not differ significantly between the IUA and saline groups (p = 0.05).

A primary limitation noted by the authors is that all included studies compared anesthetic infusion to saline infusion rather than no infusion, meaning the specific effect of the anesthetic agent versus the act of infusion is not fully clarified.

Clinically, lidocaine may be considered a simple, low-risk strategy to reduce procedural pain during IUD insertion. However, the impact of the infusion process itself on discomfort remains uncertain.

How this fits prior evidence

This meta-analysis extends prior evidence regarding the use of lidocaine for procedural pain. It specifically addresses the use of intrauterine lidocaine to reduce pain during IUD insertion, which is a distinct clinical scenario from the previously reported use of intrauterine lidocaine for hysteroscope insertion. While the previous finding for hysteroscope insertion noted a transient effect and limited benefit for distension or biopsy pain, this meta-analysis provides evidence for lidocaine's role in IUD insertion specifically.

Getting an IUD can be a painful experience for many women. New data suggests that using a local anesthetic, specifically lidocaine, directly in the uterus could help manage that discomfort during the insertion process.

Researchers looked at data from 651 women who were getting IUDs. They found that women who received an intrauterine anesthetic reported significantly less pain during the actual insertion compared to those who received a saline solution. This effect was especially clear in the group of 262 women who received lidocaine.

While the results are promising, there is a small catch. Because the study compared the medicine to a salt water solution rather than no treatment at all, it is hard to tell if the relief comes from the medicine itself or just the act of giving an infusion. Talk to your doctor about whether this low-risk option is right for you.

What this means for you:
Lidocaine may significantly reduce pain during IUD insertion, especially for women who have never given birth.

Common questions

Does lidocaine actually help with IUD pain?

Yes, the data shows that lidocaine significantly reduced pain during the insertion of an IUD. In a group of 262 women who received lidocaine, the reduction in pain was statistically significant. It is considered a simple and low-risk way to manage discomfort during the procedure.

Is this treatment effective for everyone?

The study specifically looked at both women who have never given birth and those who have. While lidocaine showed a significant reduction in pain, other types of anesthetic agents did not show a significant effect in the study of 165 women.

What are the limitations of this finding?

Because the study compared the anesthetic to a saline (salt water) infusion rather than no infusion at all, it is not fully clear if the relief comes from the lidocaine itself or just the act of giving an infusion. You should discuss these details with your doctor.

Study Details

Study typeMeta analysis
Sample sizen = 262
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
OBJECTIVES: To evaluate intrauterine anesthesia (IUA) compared with normal saline infusion for pain reduction during intrauterine device (IUD) placement. STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing IUA with saline in nulliparous and parous women undergoing IUD insertion. Eligible studies were RCTs reporting at least one pain related outcome; postpartum insertions were excluded. We searched PubMed, Embase, and Cochrane databases in November 2024. The primary outcome was pain during IUD insertion. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and heterogeneity using I². Analyses were performed in Review Manager (RevMan) version 7.12.0. RESULTS: Six RCTs involving 651 women were included; 68% were nulliparous and 49.3% received IUA. Five studies with 427 women contributed to the analysis of pain during IUD insertion, which was significantly lower with IUA compared with placebo (SMD -0.47; 95% CI -0.90 to -0.03; p = 0.04; I² = 58%). In subgroup analysis, two studies including a total of 262 patients receiving lidocaine demonstrated a significant reduction in pain during IUD insertion (p = 0.0002), whereas two studies including 165 patients utilizing other anesthetic agents showed no significant effect (p = 0.27). Pain after insertion did not differ significantly between groups (p = 0.05). All studies had low risk of bias. CONCLUSION: Intrauterine anesthesia reduced pain during IUD insertion compared with saline infusion; however, the effect of infusion itself on procedural discomfort remains uncertain. IMPLICATIONS: Intrauterine anesthesia, particularly lidocaine, may be considered as a simple and low-risk strategy to reduce pain during IUD insertion, especially among nulliparous women who are more likely to experience procedural discomfort. Improving pain control during insertion may enhance patient comfort, satisfaction, and acceptability of long-acting reversible contraception. However, because all included studies compared anesthetic infusion with saline infusion rather than no infusion, further randomized studies are needed to clarify the true analgesic effect of intrauterine anesthesia.
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