4. Nitrous oxide for intrauterine device placement in nulliparous adolescents

Abstract

<h3>Background</h3> Levonorgestrel intrauterine devices (IUDs) provide many benefits for adolescent patients. In addition to highly effective contraception, levonorgestrel IUDs treat dysmenorrhea, heavy menstrual bleeding, and menstrual dysphoria. Despite these benefits, both patients and clinicians have reservations about their use in adolescents. We hypothesize that use of nitrous oxide (N2O2) is associated with less procedural pain than non-sedated IUD placement. <h3>Methods</h3> In this IRB-approved prospective observational study, English-speaking patients aged 12 to 22 presenting to a pediatric and adolescent gynecologist for an IUD were offered in-clinic placement or placement with N2O2 in a hospital-based sedation unit. Subjects completed a questionnaire two minutes after the procedure. Pain was recorded on a 100mm Visual Analog Scale (VAS). Additional questions assessed pain levels at each step of the procedure and overall satisfaction with IUD placement. <h3>Results</h3> Seventy-four patients agreed to participate. Forty-five patients underwent IUD placement in clinic. Twenty-nine patients elected N2O2. Of these 29, four had no response on the VAS. A total of 25 patients with N2O2 were assessed for the primary outcome. Mean procedural pain score was 24.72mm (+/-23.9) in the N2O2 group and 54.07mm (+/-20.85) in the clinic group (P<0.0001). Regardless of N2O2 use, 91.8% of participants stated they would be completely, very, or moderately likely to have an IUD again; 94.5% stated they would be completely, very, or moderately likely to recommend an IUD to a friend. <h3>Conclusions</h3> N2O2 reduced pain with IUD insertion in adolescents. Adolescents express high levels of satisfaction with IUD placement regardless of N2O2 use.