Does the cervical canal passage axis have an effect on pain sensation in IUD application?: a randomized controlled trial

Yıl 2020, , 330 - 335, 18.06.2020

Buğra Çoşkun , Mahmut Kuntay Kokanalı , Ramazan Erda Pay , Coşkun Şimşir , Mehmet Ferdi Kıncı , Bora Çoşkun , Tolga Ecemis , Kazım Emre Karaşahin

https://doi.org/10.32322/jhsm.738957

Öz

Aim: To investigate the effect of the axis of the IUD wings in the cannula on the pain felt while passing the cervical canal.
Material and Method: Ninety-one patients who underwent IUD application in the family planning policlinic were enrolled in the study. The patients were randomly divided into two groups according to the IUD application sequence number. Odd numbers were included in the 'Transverse application' (Group I), while even numbers were included in the 'Vertical application' (Group II) group. After the procedure, patients were informed about the visual analog scale (VAS) by another doctor who did not perform the procedure. Patients rated pain intensity during the procedure from 0 (zero, painless) to 10 (ten, highest pain) on VAS.
Results: No statistically significant difference was found between the groups in terms of age, gravida, parity, body mass index, cervical length, previous cesarean history, presence of retroverted uterus. There was no statically significant difference according to VAS scores between the groups, but the mean VAS score was lower in Group II. Also, the presence of severe pain (VAS score>8) was statistically significantly higher in Group I. Transverse application procedure (OR: 1.21, 95% CI: 0.21-6.70, p = 0.042) was found to be a significant independent factor for the presence of severe pain in multiple regression analysis.
Conclusion: In the IUD application procedure, passing the cervical canal while the wings in cannula are in the vertical axis has been associated with less pain felt.

Anahtar Kelimeler

Intrauterine device, pain, visual analog scale

RİA uygulamasında servikal kanalı geçiş ekseninin ağrı hissine etkisi var mıdır?: randomize kontrollü bir çalışma

Öz

Amaç: Rahim içi araç uygulamasında servikal kanal geçerilirken kanül içerisindeki kanatların ekseninin hissedilen ağrıya etkisini araştırmak
Gereç ve Yöntem: Aile planlaması polikliniğinde rahim içi araç uygulaması yapılan 91 hasta çalışmaya dahil edildi. Hastalar rahim içi araç uygulama sıra numarasına göre rastgele iki gruba ayrıldı. Tek sayılar ‘Yatay uygulama’ (Grup I), çift sayılar ise ‘Dikey uygulama’ (Grup II) grubuna dahil edildi. İşlem sonrası hastalar, başka bir doktor tarafından vizüel analog skala hakkında bilgilendirildi ve işlem sırasında hissettikleri ağrı yoğunluğunu vizüel analog skalaya göre 0 (sıfır, ağrısız) ila 10 (on, en yüksek ağrı) arasında derecelendirdi.
Bulgular: Gruplar arasında yaş, gravida, parite, vücut kitle indeksi, servikal uzunluk, sezaryen öyküsü, retrovert uterus varlığı açısından istatistiksel olarak anlamlı bir fark yoktu. Gruplar arasında vizüel analog skala skorlarına göre istatistiksel olarak anlamlı fark yoktu, ancak Grup II’de ortalama vizüel analog skala skoru daha düşüktü. Ayrıca Grup I’deki şiddetli ağrı varlığı (vizüel analog skala skoru>8) istatistiksel anlamlı daha yüksekti. Enine uygulama prosedürü (OR:1,21, %95 CI:0,21-6,70, p=0,042) çoklu regresyon analizinde şiddetli ağrı varlığı için anlamlı bir bağımsız faktör olarak bulunmuştur.
Sonuç: Rahim içi araç uygulama prosedüründe, kanüldeki kanatlar dikey eksendeyken servikal kanalı geçmek daha az ağrı hissi ile ilişkilendirilmiştir.

Anahtar Kelimeler

Rahim içi cihaz, ağrı, vizüel analog skala

Kaynakça

• 1. Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. Lancet 2006; 368: 1810-27.
• 2. Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet 2012; 380: 149-56.
• 3. d’Arcangues C. Worldwide use of intrauterine devices for contraception. Contraception 2007; 75: 2-7.
• 4. Allen RH, Bartz D, Grimes DA, Hubacher D, O’Brien P. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev 2009.
• 5. Kapp N, Curtis KM. Intrauterine device insertion during the postpartum period: a systematic review. Contraception 2009; 80: 327-36.
• 6. Cetin A, Cetin M. Effect of deep injections of local anesthetics and basal dilatation of cervix in management of pain during legal abortions: a randomized, controlled study. Contraception 1997; 56: 85-7.
• 7. Cooper N, Smith P, Khan K, Clark T. Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain. BJOG 2010; 117: 532-9.
• 8. Bednarek PH, Creinin MD, Reeves MF, et al. Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial. Contraception 2015; 91: 193-7.
• 9. McNicholas CP, Madden T, Zhao Q, Secura G, Allsworth JE, Peipert JF. Cervical lidocaine for IUD insertional pain: a randomized controlled trial. Am J Obstet Gynecol 2012; 207: 384.
• 10. Karabayirli S, Ayrım AA, Muslu B. Comparison of the analgesic effects of oral tramadol and naproxen sodium on pain relief during IUD insertion. J Minim Invasive Gynecol 2012; 19: 581-4.
• 11. Grimes DA, Hubacher D, Lopez LM, Schulz KF. Non‐steroidal anti‐inflammatory drugs for heavy bleeding or pain associated with intrauterine‐device use. Cochrane Database Syst Rev 2006; 4: CD006034.
• 12. Murty J. Use and effectiveness of oral analgesia when fitting an intrauterine device. J Fam Plann Reprod Health Care 2003; 29: 150-1.
• 13. Lopez LM, Bernholc A, Zeng Y, et al. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev 2015.
• 14. Abbas AM, Ali SS, Salem MN, Sabry M. Effect of oral ketoprofen on pain perception during copper IUD insertion among parous women: a randomized double-blind controlled trial. Middle East Fertil Soc J 2018; 23: 491-5.
• 15. Crawford M, Davy S, Book N, Elliott JO, Arora A. Oral ketorolac for pain relief during intrauterine device insertion: a double-blinded randomized controlled trial. J Obstet Gynaecol Can 2017; 39: 1143-9.
• 16. Aksoy H, Aksoy Ü, Ozyurt S, Açmaz G, Babayigit M. Lidocaine 10% spray to the cervix reduces pain during intrauterine device insertion: a double-blind randomised controlled trial. J Fam Plann Reprod Health Care 2016; 42: 83-7.
• 17. Garris RE, Kirkwood CF. Misoprostol: a prostaglandin E1 analogue. Clin Pharm 1989; 8: 627-44.
• 18. Mansy AA. Does sublingual misoprostol reduce pain and facilitate IUD insertion in women with no previous vaginal delivery? A randomized controlled trial. Middle East Fertil Soc J 2018; 23: 72-6.
• 19. Ibrahim ZM, Sayed Ahmed WA. Sublingual misoprostol prior to insertion of a T380A intrauterine device in women with no previous vaginal delivery. Eur J Contracept Reprod Health Care 2013; 18: 300-8.
• 20. Stempinski-Metoyer K, Madrigal J, Adam M, Patel A. Utility of the comfort, assurance, language model (CALM) as a non-pharmacological intervention for pain relief during IUD insertion. Contraception 2018; 98: 354.
• 21. Hylton J, Milton S, Sima A. Cold compress for pain associated with intrauterine device insertion: a randomized controlled trial. Obs Gyn 2018; 131: 76.
• 22. Houdeau E, Rousseau A, Meusnier C, Prud’Homme MJ, Rousseau JP. Sympathetic innervation of the upper and lower regions of the uterus and cervix in the rat have different origins and routes. J Comp Neurol. 1998; 399: 403‐12.
• 23. Aleksandrovych V, Kurnik-Łucka M, Bereza T, et al. The Autonomic Innervation and Uterine Telocyte Interplay in Leiomyoma Formation. Cell Transplant 2019; 28: 619–29.