Randomized Controlled Trial of a Paracervical Block for Pain Control Among Adolescents Receiving the 13.5 mg Levonorgestrel Intrauterine System

A major barrier to use of intrauterine systems (IUS) among adolescents is fear of pain during the procedure. Existing studies of pain control options focus on adult women. We examined the effect of a 1% lidocaine paracervical anesthetic nerve block on pain during IUS insertion among adolescent women. We hypothesized that participants in the block group would experience less pain that participants in the sham group. Ninety-five women were randomized to receive a 10-mL 1% lidocaine paracervical anesthetic block or a sham block 3-minutes prior to insertion of a 13.5 mg levonorgestrel IUS. Subjects were recruited from 2 urban adolescent medicine clinics, 3 urban pediatric primary care clinics, 3 university student health centers, and 2 family planning clinics in Philadelphia, Pennsylvania. Women recorded their pain on a 100-mm visual analogue scale (VAS) (0 mm=no pain, 100 mm=worst pain ever). Institutional Review Board approval was granted by our institution. The 95 participants were 81% age 18 or older, 44% White, 36% Black, 9% Hispanic. Two out of three participants had taken college courses and had private health insurance. Most were sexually active (92%), but never had a vaginal speculum exam (56%) or Pap smear (69%). At the time of Skyla placement, the sham group reported higher pain levels (40% reported >80mm; median=71.5mm) than the block group (13% reported >80mm; median=30mm) with a p-value <0.01. Compared to a sham block, a 1% lidocaine paracervical block significantly reduced adolescents’ perceived pain during IUS insertion. Nerve blocks may be a useful adjunct in the procedural process for IUS insertions among adolescents.