What is the role of anesthesia in intrauterine device (IUD) insertion?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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No anesthesia or analgesia is indicated for insertion of either the copper T380A or the levonorgestrel-releasing IUDs. [28, 29]

Pain during insertion is likely multifactorial; possible sources include placement of speculum, use of tenaculum on cervix, cervical and uterine irritation from passing the sound, and placement of the IUD. Patients who experience increased pain with insertion are more commonly nulliparous, under 30 years of age, are nonlactating, or have had a longer interval since their last pregnancy or last menses. [28] The preprocedure expectation of pain is also thought to contribute to perceived pain with IUD insertion, emphasizing the importance of preprocedure counseling. [29]

Anecdotally, paracervical blocks have been used if insertion was previously abandoned secondary to patient discomfort or there is significant concern regarding patient tolerance of procedure. Multiple studies have researched the effect of preinsertion nonsteroidal anti-inflammatory drugs (NSAIDs) on patient discomfort during IUD insertion, and no significant improvement in patient discomfort has been elucidated. [28, 29, 30]

Saav et al. [31] evaluated the effect of preprocedure placement of misoprostol for cervical ripening. While misoprostol given 1 hour prior to placement was found to facilitate placement, there was no significant effect on patient discomfort or procedural complications. This argues against routine use of misoprostol for cervical ripening prior to IUD placement.

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