Comparison Of Effectiveness Of Counselling Only, Suppository Diclofenac And Lidocaine Spray At Intrauterine Device Insertion In A Tertiary Hospital In Ghana

Abstract

Objective: Perception of pain at IUD insertion is one of the main barriers of its uptake. Several pharmacological and non-pharmacological interventions have been studied but currently there is no consensus on the pain management at IUD insertion. The study aim was to compare the effectiveness of counselling only, 10% lidocaine spray of the cervix and 100mg suppository diclofenac in reducing pain at IUD insertion. Methodology: A prospective study of 99 respondents were randomized into 3 study arms; suppository diclofenac, lidocaine spray and counselling only in a ratio of 1:1:1. All participants had a baseline counselling: while those in the diclofenac arm were given 100mg diclofenac suppository 30 minutes before the procedure, those in the 10% lidocaine spray arm were given 4 pumps on the cervix before the insertion. A 10cm- Visual Analog Scale was used to assess the pain experienced during and after IUD insertion. Chi-square test, one-way ANOVA and a Post-Hoc test were used for the statistical analysis. P value of < 0.05 and confidence interval of 95% were used. Results: Suppository diclofenac was superior to counselling only at speculum insertion, tenaculum application, uterine sounding, IUD placement, immediately and 5 minutes after procedure. Lidocaine spray of the cervix was also superior to counselling only throughout the procedure and up to 4 hours post procedure. Lidocaine spray of the cervix was superior to suppository diclofenac at 5 minutes and 4 hours after procedure. Conclusion: Lidocaine spray (10%) of cervix is more effective compared to 100mg Diclofenac Sodium and Counselling only in reducing pain at IUD insertion.