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Published on: January 31, 2025
Evaluating changes in lidocaine and opioid administration on the day of IUD insertion, 2018-2025
Nina B Masters1, Karen Gilbert Farrar1, Brianna M Goodwin Cartwright1
1Truveta, Inc., Bellevue Washington, WA, United States.
Objectives:
Intrauterine devices (IUDs) are highly effective, long-acting reversible contraceptives. The CDC updated their Selected Practice Recommendations for Contraceptive Use in August 2024, including guidance on pain management during IUD insertions. This study describes real-world trends in the use of lidocaine and opioids on the day of IUD insertion.
Study Design:
This study used a subset of Truveta Data, a daily updated electronic health record database from a collective of US health care systems. Lidocaine and opioid medications ordered or administered on the day of the IUD insertion were captured, and logistic interrupted time series models were used to evaluate predictors of receipt and quantify the impact of the 2024 recommendations.
Results:
There were 286,144 IUD insertions meeting study criteria from 1/1/2018 - 6/30/2025. In 2018, 1.7% of patients received any pain medication, increasing to 5.0% in 2025. CDC guidelines were associated with an 18% immediate increase in the odds of lidocaine receipt (aOR 1.18, 95% CI: 1.05, 1.34) and a 22% increase in the odds of opioid receipt on the day of IUD insertion (aOR 1.22, 95% CI: 1.04, 1.44). The monthly trend of both lidocaine and opioid receipt did not change after the guidelines.
Conclusions:
Despite a statistically significant increase in lidocaine and opioid use on the day of IUD placement after the CDC guidelines, in 2025, 95% of IUD recipients did not receive either pain control method. Our reliance on structured billing and medication fields may have missed lidocaine and opioid use documented only in clinical notes, which could lead us to underestimate utilization.
Implications:
Intrauterine device (IUD) insertion is painful, and pain management is uncommon. Despite 2024 CDC guidelines encouraging pain management during IUD insertions, leading to a statistically significant increase in both lidocaine and opioid receipt on the day of the procedure, 95% of women did not receive either of these pain control methods with their IUD insertion in 2025.
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