(71) IUD Insertion Under Conscious Sedation: Patient Characteristics and Clinical Outcomes

Background: The intrauterine devices (IUD) are a favorable option for adolescents for contraception and menstrual suppression. However, adolescents may defer this option due to anxiety of the genital exam and/or pain of IUD insertion. Published options for pain management during IUD insertion thus far have shown inconsistent results. To our knowledge, most institutions offer in-office IUD insertion or insertion with general anesthesia in the operating room. Alternatively, conscious sedation techniques have been utilized by multiple pediatric subspecialties to effectively and safely manage pain and anxiety at time of bedside procedures. Therefore, our institution began offering conscious sedation to mitigate anxiety and pain during IUD insertion. The objective of this study was to determine the characteristics and outcomes of adolescents who choose to have their IUD inserted with conscious sedation.

Methods: This was an IRB approved (STUDY2778) single-site, retrospective cohort study evaluating all patients who had an attempted IUD insertion using conscious sedation by the pediatric & adolescent gynecology department. Charts were reviewed from 3/16/2022-4/28/2023 and data was stored in REDCap. Demographics, medical history, procedure information, and follow-up data was collected and verified by a second reviewer. Sample statistics including proportions, z-tests, t-tests, and odd ratios were used for analysis.

Results: There were 69 IUD attempted with conscious sedation. Of the encounters, 52 (75.4%) were with nitrous gas and 17 (24.6%) were with IV fentanyl & versed. There were 64 (92.7%) successful IUD insertions and 5 (7.3%) failed insertions. The average patient was 16.2 years old (range 11.9-20.4 years old) and 17 (24.6%) did not identify as cis-gender. Patients who were sexually active had a 10.0 increased odds to choose light over moderate sedation (p=0.031, 95% CI 1.2 – 81.3). Other factors, such as age, history of sexual assault, tampon use, and gender identity did not significantly influence choice of sedation type or the risk of a failed IUD insertion.

Conclusions: In conclusion, sexual activity may indicate a preference for nitrous versus IV sedation, however other factors such as age, history of sexual assault, tampon use, and gender identity did not significantly influence patient’s choice in sedative option. Success rates were also not significantly affected by any of the factors observed within our cohort. Knowing the characteristics of patients who choose nitrous versus IV sedation, as well as how it relates to successful insertion, may help guide pre-procedural counseling for patients interested in sedation at time of IUD insertion.