(135) Teen and Young Adult Experiences with Intrauterine Device Placement under Procedural Sedation: A Pilot Study

Background: Intrauterine devices (IUDs) are a reliable method of contraception and menstrual management, but their use can be limited by concerns for pain and anxiety with placement. Pain management for IUD insertion is recommended prior to placement, but data regarding multiple modes of analgesia and anxiolysis have shown mixed results. This study is designed as a pilot study to analyze adolescent experiences with IUD placement with sedation and to identify patient characteristics that may be associated with a favorable or unfavorable experience.

Methods: This is a single-site, prospective cohort study with IRB approval performed over a six-month period. Patients planning to have IUD placement with sedation self-selected into sedation type: nitrous oxide (“light sedation”) or intravenous midazolam and fentanyl (“moderate sedation”). Recruited participants were age 11-21. Participants responded to surveys before the procedure to provide demographics, anticipated pain, and reproductive health history. They completed surveys after IUD placement to report pain levels and overall experience. Information from treating providers determined type of sedation used, indication for sedation, procedural complications, and provider estimation of patients’ tolerance for the procedure.

Results: From this cohort, 78% of patients received intravenous midazolam/fentanyl for sedation, while 17% received nitrous oxide. Maximum pain levels were significantly less in patients who received moderate sedation as compared to light sedation (p=0.026). Several hours following the procedure, average pain was a 4.7 and not statistically different between groups. All patients who received light sedation remembered the events of the insertion while only 11% of those who received moderate sedation did. Adolescents who had never been sexually active before had significantly more pain after completion of the procedure (p=0.006) with no difference in procedural pain. Patients reported an average satisfaction score of 77 on a 100-point visual analogue scale, with no difference between sedation types.

Conclusions: Participants who received moderate sedation had significantly decreased pain scores as compared to those who received light sedation. Patients who had not previously had consensual sex had post-procedural pain elevated above their counterparts with a history of sexual activity. Overall, patients were highly satisfied with the procedural sedation, regardless or sedation type or pain level experienced. As this study is expanded beyond the pilot for a more diverse group of participants, it will guide future clinical practice and patient counseling.