Use of Paracervical Blocks for Patients Who Undergo Intrauterine Device Insertion

Area of Science:

• Reproductive Health
• Pain Management
• Health Equity

Background:

• Paracervical blocks can alleviate pain during intrauterine device (IUD) insertions.
• The practical application and influencing factors of paracervical block use for IUD insertions remain unclear.

Purpose of the Study:

• To investigate the utilization patterns of paracervical blocks during IUD insertions within an academic health system.
• To identify patient, clinician, and clinic-level factors associated with paracervical block receipt.

Main Methods:

• Retrospective cross-sectional time-series analysis of electronic health record data from July 2012 to August 2024.
• Inclusion of 13,702 IUD insertions, with analysis of paracervical block receipt based on clinic, clinician, and patient variables.
• Multilevel models and causal mediation analysis were employed to assess associations and the role of clinic specialty.

Main Results:

• Overall, 38.8% of IUD insertions included a paracervical block, with significant variations across specialties and appointment lengths.
• Lower odds of receiving paracervical blocks were observed in non-OB-GYN specialties, shorter appointments, and for Latine patients and those with a non-English language preference.
• Patients under 18 years had lower receipt rates, partly mediated by care in pediatrics/adolescent medicine clinics.

Conclusions:

• Factors such as Latine ethnicity, non-English language preference, lack of prior patient-clinician interaction, and shorter appointment durations are linked to reduced paracervical block use.
• Strategies to enhance paracervical block access should focus on improving training, implementing equitable clinic policies, and ensuring adequate appointment times.
• Addressing these disparities is crucial for improving pain management and equity in reproductive healthcare services.