Painless IUD will be available to use soon.
Minimizing the pain of the IUD insertion: all effort required By Dr. Roberto Leon on July 12, 2016 I offer them 1-2 mg of sublingual lorazepam 30 min prior to insertion as long as they get a drive home. Naproxen or Ibuprofen is given 1-2 hours earlier for uterine cramps. To reduce the cervical pain, a paracervical block is performed with10 cc of 1% Xylocaine 1%. A spinal needle with a control syringe is employed to minimize the risk of intravascular injection. Patients are informed all along what is happening, especially as the needle goes into the stroma of the cervix. Many women do not feel the needle at all, some feel a slight discomfort. After injecting 2 cc at 12 o’clock, a tenaculum is placed to lift the cervix and 4 cc are injected on each side at the 4-5 and 7-8 o’clock positions. The block may take 2-3 minutes to work. To confirm that it is effective, and to allow some further cervical dilatation, an os finder is introduced into the uterus. Premedication with ibuprofen (600 mg) or naproxen (500 mg) 1-2 hours before is given to minimize the pain of the IUD deployment. Gentle manipulation is paramount. The patient is kept supine for another 5 minutes, while questions are addressed. A bedside transvaginal ultrasound is performed in selected cases, such as in women who have a higher risk than normal for uterine perforation (examples include previous C/Section, especially if they are still breastfeeding, or a markedly retroverted uterus). Perforations usually occur at the time of insertion. If a partial perforation is noted , then the IUD is removed immediately. A most recent Cochrane review in 2015 (3) states that “Lidocaine 2% gel, misoprostol, and most NSAIDs did not help reduce pain. Some lidocaine formulations, tramadol, and naproxen had some effect on reducing IUC insertion-related pain in specific groups”. Most studies looking at pain management during insertion compared one intervention to none, showing limited benefits. Patient Handouts Handout: After a COPPER IUD insertion https://lnkd.in/g-TZH9pV Handout: After a MIRENA or JAYDESS IUD insertion https://lnkd.in/g8dJAcBu