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Pain control during IUD insertion

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Intrauterine contraception is a LARC method that is more cost-effective, has higher user continuation rates and offers other benefits to women compared to other LARC methods. The procedure for the insertion of an intrauterine device (IUD) is associated with pain and/or discomfort in some women, which is a known barrier to intrauterine contraception use. Health professionals differ in their opinions on women's perceptions of pain or discomfort, as well as about the use of local anaesthesia (LA) for IUD insertions.

According to the WHO’s Family planning: A global handbook for providers (2018 edition), ibuprofen (200–400 mg), paracetamol (325–1000 mg), or other pain reliever may be given 30 minutes before insertion to help reduce cramping and pain. Do not give aspirin, which slows blood clotting.

Pain control should be an objective of all health professionals in their routine practice when providing care. Maguire et al (2013) showed that providers underestimate pain during IUD insertion.

A survey was undertaken using paper questionnaires to determine LA use for IUD insertion by UK health professionals. Overall, approximately one quarter (n=129) of all respondents use LA routinely. Use of LA was more prevalent among health professionals who worked in integrated sexual and reproductive health and contraception-only services, compared to general practice.

Hutt (2011) proposes routine intracervical block with 8-10cm of 1% lidocaine for all IUD insertions, unless requested by the patient not to do so. The described technique is simple, low cost, requires no special equipment, and adds no more than 30-60 seconds to insertion time. The advantages of using a local anaesthetic are minimal discomfort felt during insertion; postinsertion cramping is eliminated or greatly reduced; elimination of cervical shock or vasovagal reaction during or just after insertion; maximal patient cooperation allowing easier attainment of absolute no touch technique and ensuring correct placement of the device; reduction in recovery and resting time following insertion; and a positive influence on patient acceptance of the device due to pain-free insertion.

The routine use of intracervical local anesthesia (ILA) for IUD insertion is recommended as a means of achieving greater patient and doctor satisfaction and reduced insertion appointment time.

“ILA is simple, safe, quick and painless to administer and immediately effective. Without overwhelming cervical pain there will be less cervical shock. This means surgeries are less likely to be clogged by women collapsing, experiencing unpleasant and avoidable vasovagal attacks,” Hutt stated.

A small 2017 study (Akers et al |(2017) looked at adolescents and young women who had never given birth. About half of the group received a 10-milliliter injection of lidocaine, known as a paracervical nerve block. The other group received a placebo treatment (sham block). After an IUD insertion procedure, the researchers compared the pain scores of the participants. The pain scores were significantly lower in the group that received the lidocaine treatment, compared to the group that didn’t.

The median visual analogue scale score after IUD insertion was 30.0 (95% CI 20.0-58.0) in the lidocaine block group and 71.5 (95% CI 66.0-82.0) in the sham block (P<.001).

Conclusion

A 10-mL 1% lidocaine paracervical nerve block reduces pain during IUD insertion in adolescents and young women compared with a sham block with pressure on the vaginal epithelium.

References available on request.

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