A groundbreaking study revealed that intrauterine mepivacaine can significantly reduce pain during intrauterine device placement in nulliparous women who are at high risk of unintended pregnancy as per a trial that was published in the American Journal of Obstetrics & Gynecology.
Providing access to successful and effective contraceptive methods is necessary for comprehensive family planning among women in the reproductive age group. Long-acting reversible contraception (LARC), such as intrauterine devices (IUDs) and subdermal implants are the most effective reversible contraceptive options available and recommended as per international guidelines. However, fear of pain and discomfort during the IUD placement is a major barrier to the uptake of IUDs among nulliparous women. Hence, researchers conducted a trial to assess whether the instillation of intrauterine mepivacaine before IUD placement alleviates pain more effectively than a placebo.

a multicenter, double-blind, randomized, placebo-controlled trial was carried out involving nulliparous women who were ready for IUD placement. A hydrosonography catheter was used for the intrauterine instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride and administrated 2 minutes before IUD placement. A 100 mm visual analog scale (VAS) was used to assess pain at prespecified time points. The primary outcome was to assess the difference in VAS pain scores between the intervention group and the placebo group during IUD placement. Secondary outcomes included VAS pain scores at instillation and 10 minutes after placement, tolerability of the placement pain, as well as acceptability of the analgesia method.
Findings:
About 151 participants were enrolled, with 76 randomized to the mepivacaine group and 75 to the placebo group.
The mean VAS pain score during IUD placement showed a difference of 13.3 mm.
The mepivacaine group had a mean of 53.9 mm, while the placebo group had a mean of 67.2 mm suggesting that mepivacaine was effective in reducing the pain.
A statistically significant difference between the pain scores was seen after adjusting for each individual provider’s impact.

A greater proportion of women in the intervention group reported tolerable pain during placement with 70/75 participants (93.3%) compared to 53/66 participants (80.3%) in the placebo group.
Thus, the study concluded that intrauterine instillation of mepivacaine results in a statistically significant reduction in pain scores among nulliparous women during IUD placement. The researchers concluded that there was a reported high acceptance of the IUD after mepivacaine due to tolerable pain levels reported by women.
Thus, intrauterine mepivacaine installation has better clinical relevance during IUD placement in reducing pain in nulliparous women who are at high risk of unintended pregnancy.