Intracervical block for levonorgestrel-releasing intrauterine system placement among nulligravid women: a randomized double-blind controlled trial

Nadai, Mariane Nunes de; Neto, Omero Benedicto Poli; Franceschini, Sílvio Antônio; Yamaguti, Erciliene M.M.; Monteiro, Ilza; Troncon, Júlia Kefalás; Juliato, Cássia Raquel Teatin; Santana, Lícia Santos; Bahamondes, Luís; Vieira, Carolina Sales

doi:10.1016/j.ajog.2019.09.013

Cited by 12 publications

(10 citation statements)

References 42 publications

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“…Since the time of this study, four randomized trials demonstrated significantly less pain in young, nulliparous and nulligravid patients who received a paracervical block before IUD placement. [3][4][5][6] Greater use of cervical anaesthesia in this study may have resulted in participants experiencing less pain.…”

Section: Discussionmentioning

confidence: 93%

Feasibility study of a single‐handed inserter for levonorgestrel 52 mg intrauterine device placement

Eisenberg,

Schreiber,

Blumenthal

et al. 2023

Repro Female Child Health

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ObjectiveTo assess placement outcomes using a levonorgestrel 52 mg intrauterine device (IUD) inserter designed for single‐handed use.MethodsInvestigators enroled participants 18–45 years to have the IUD inserted using a redesigned inserter with removal 5–15 min after placement. Physicians and participants provided feedback on their insertion experience.ResultsSuccessful placement occurred in 48 of 50 (96.0%) enroled participants. Investigators rated insertion device loading “easy” in 49 (98.0%) and placement “easy” in 44 (88.0%) cases. Cramping pain was reported at insertion by 47 (94.0%) participants, mostly mild (32 [64.0%]) or moderate (11 [22.0%]).ConclusionThe single‐handed inserter is easy to use and results in high rates of insertion success.

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Section: Discussionmentioning

confidence: 93%

Feasibility study of a single‐handed inserter for levonorgestrel 52 mg intrauterine device placement

Eisenberg,

Schreiber,

Blumenthal

et al. 2023

Repro Female Child Health

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show abstract

“…This shows that the technique was well-tolerated by more than 90% of patients, even without any pain management. Paracervical or intracervical block, used to reduce the pain associated with IUD insertion 17,18 , may represent alternatives for cases with severe pain during the IUD repositioning procedure. However, no studies have evaluated this approach.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Yamaguti

Reis

Martins³

et al. 2023

Ultrasound in Obstet & Gyne

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Objective To describe the feasibility of an ultrasound‐guided repositioning technique for partially expelled intrauterine devices (IUDs) without use of sedation. Methods This was a descriptive feasibility study of patients with a partially expelled IUD managed in our outpatient clinic from January 2016 to February 2020. The partially expelled IUDs (vertical arm extending partially or entirely through the cervical canal) were repositioned at the uterine fundus using Hartmann alligator forceps under ultrasound guidance. Paracervical or intracervical anesthesia and prophylactic antibiotics were not used. Data related to the procedure and 6‐month follow‐up were extracted from patient medical records. The primary outcome was the success rate of the repositioning procedure, defined as ultrasound confirmation of the entire IUD located above the internal os. Secondary outcomes included the retention and expulsion rates of the repositioned IUD at 6 months after the procedure and description of complications. Results We included data from 55 women with a partially expelled IUD (35 levonorgestrel IUDs and 20 copper IUDs) referred for repositioning. Ultrasound‐guided repositioning of the IUD was successful in 51 (92.7%) cases, while the procedure was not completed in four patients due to pain. Of the 55 procedures, 48 (87.3%) were performed by obstetrics and gynecology trainees under the supervision of a senior specialist. Among the 51 successfully repositioned IUDs, nine (17.6%) were expelled within 6 months after the procedure and six patients were lost to follow‐up. No uterine perforation or infection‐related complications occurred within 6 months of the procedure. Conclusion The ultrasound‐guided repositioning technique appears to be a safe and feasible approach for partially expelled IUDs. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

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“…When the panelists considered the management of the insertion in nulligravida, despite having no specific orientations, more than one third recommended the intracervical block or complementary analgesia. Although some physicians perceive the insertion as more painful and difficult in nulligravidas, the literature shows that the procedure is simple and well-tolerated by this group [15,16]. In general, there is no clear guidance and besides the use of lidocaine as intracervical block for nulligravidas, no treatment for pain has shown superiority over others [17].…”

Section: Discussionmentioning

confidence: 99%

“…Most participants reported the use of NSAIDs before and after the insertion. Evidence shows that the fear of the insertion procedure can prevent many women from choosing this method [15], therefore, we consider valid any strategy to reduce pain at the insertion, as long as they do not become a barrier to the use of LNG IUS, given the fact that most women do not require anesthesia. Some participants wait before abandoning previous contraceptive methods.…”

Section: Discussionmentioning

confidence: 99%

Practical Recommendations on the Management of Issues Related to the Levonorgestrel 52mg Intrauterine System: A Delphi Panel

Ushikusa

2021

OAJBS

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Objective: To gather the routine practice of Brazilian physicians with large experience on the Levonorgestrel 52mg intrauterine system (LNG IUS) use in order to generate practical recommendations on how to manage common aspects related to it. Material and Methods:Twenty gynecologists with large experience with LNG IUS answered 39 questions grouped into five main topics: exams before the procedure, technical aspects of the device placement, practical recommendations, irregular bleeding, and pregnancy. A second round of questions was carried when responses were very divergent.Results: Eighteen panelists responded to the questions. Recommendations that had more than 90% of agreement were i) the gynecological exam is the most important assessment before the insertion of LNG IUS; ii) in case of expulsion, a new device could be inserted; iii) there is no minimum age after menarche to use LNG IUS as a contraceptive, and iv) the device can be maintained after menopause. All the panelists responded that the duration of the insertion procedure was less than 10 minutes. Some topics did not reach more than 50% of agreement. Conclusion:Most aspects related to LNG IUS usage reached an agreement in terms of clinical practices among physicians with different backgrounds, and also tend to correlate to the available guidelines. However, despite the availability of LNG IUS in Brazil for many years, there is still some disagreement regarding routine practices. There is a need for continuous education of physicians and the standardization of certain procedures to expand the use of this contraceptive method.

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Intracervical block for levonorgestrel-releasing intrauterine system placement among nulligravid women: a randomized double-blind controlled trial

Cited by 12 publications

References 42 publications

Feasibility study of a single‐handed inserter for levonorgestrel 52 mg intrauterine device placement

Feasibility study of a single‐handed inserter for levonorgestrel 52 mg intrauterine device placement

Ultrasound‐guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Practical Recommendations on the Management of Issues Related to the Levonorgestrel 52mg Intrauterine System: A Delphi Panel

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