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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-23082020-134107
Document
Author
Full name
Letícia Sanchez Ferreira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2020
Supervisor
Committee
Macedo, Carolina Sales Vieira (President)
Guazzelli, Cristina Aparecida Falbo
Franceschini, Silvio Antonio
Silva, Ana Carolina Japur de Sá Rosa e
Title in Portuguese
Fatores preditores de dor severa relacionada à inserção de sistema intrauterino liberador de levonorgestrel em nuligestas
Keywords in Portuguese
Contracepção
Dor
Nuligestas
Sistema intrauterino liberador de levonorgestrel
Abstract in Portuguese
Objetivos: Identificar fatores sociodemográficos e clínicos associados à dor severa na inserção do sistema intrauterino liberador de levonorgestrel (SIU-LNG) em nuligestas. Métodos: Trata-se de uma análise secundária de um ensaio clínico randomizado (ECR) que avaliou o bloqueio intracervical de lidocaína para dor durante a inserção do SIU-LNG. Para essa análise, as participantes do ECR foram divididas em dois grupos: 1) com dor severa, mulheres com escore de dor na escala visual analógica (EVA) ≥7; e 2) sem dor severa, mulheres com EVA <7. Nós usamos teste de qui quadrado para comparar variáveis sóciodemográficas e clínicas entre os dois grupos. As variáveis que foram significantes (p<0,25) na análise univariada foram incluídas no modelo de regressão binomial múltipla, o qual foi usado para determinar preditores de dor severa na inserção do SIU-LNG. Resultados: Das 300 nuligestas que inseriram o SIU-LNG com sucesso, 137 (45,7%) relataram dor severa na inserção. Ter história de dismenorreia (p=0,001) e intervenção realizada antes da inserção do SIU-LNG no ECR (p <0,0001) associaram-se à dor severa. Na regressão múltipla, receber bloqueio intracervical de lidocaína reduziu o risco de apresentar dor severa em relação a não receber nenhuma intervenção [Risco Relativo (RR): 0,55; Intervalo de Confiança (IC) 95%: 0,37-0,80]. Mulheres com história de dismenorreia foram mais prováveis de apresentar dor severa comparadas com àquelas sem história [RR 1,36; (IC 95%: 1,08-1,72)]. Conclusão: Em nuligestas, história de dismenorreia aumenta o risco de dor severa na inserção do SIU-LNG, enquanto o bloqueio intracervical de lidocaína reduz esse risco.
Title in English
Predictors of severe pain associated with levonorgestrelreleasing intrauterine device placement in nulligravid women
Keywords in English
Contraception
Levonorgestrel intrauterine system
Nulligravidas
Pain
Abstract in English
Objective: To identify sociodemographic and clinical factors associated with severe pain at the time of insertion of a 52mg levonorgestrel intrauterine system (LNG IUS) among nulligravid women. Methods: This is a secondary analysis of a randomized clinical trial (RCT) that evaluated a lidocaine intracervical block for pain during LNG IUS insertion. For this analysis, the participants of the RCT were divided into two groups: 1) those who had severe pain, meaning a visual analog scale (VAS) pain score ≥7, and 2) those without severe pain, meaning a pain score <7. We used the Chi Squared test to compare demographic and clinical variables between these two groups. The variables that were significant (p<0.25) on univariate analysis were included in the multiple binomial regression model, which was used to determine predictors of severe pain at LNG IUS insertion. Results: Of 300 nulligravid women who had a successful LNG IUS insertion, 137 (45.7%) reported severe pain at the time of insertion. History of dysmenorrhea (p=.001) and having had an intervention done prior to the LNG IUS insertion (p <.0001) were associated with severe pain. On multiple regression analysis, receiving an intracervical lidocaine block reduced the risk of having severe pain compared to no intervention [Relative Risk (RR): 0.55; 95% Confidence Interval (CI): 0.37-0.80]. Women with a history of dysmenorrhea were more likely than those without to have severe pain [RR 1.36; (95%CI): 1.08-1.72]. Conclusions: Among nulligravid women, a history of dysmenorrhea increases the risk of severe pain at LNG IUS insertion, while a lidocaine intracervical block reduces this risk.
 
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Publishing Date
2020-10-19
 
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