Cervical Block Procedure for IUD Insertion

Types of Cervical Blocks for IUD Insertion

The American College of Obstetricians and Gynecologists recommends using a 27-gauge needle to inject 4 mL of 2% lidocaine intracervically at the 3, 6, 9, and 12 o'clock positions before tenaculum placement 1
If 2% lidocaine is unavailable, 1% lidocaine with a standard syringe can be used as an alternative, as suggested by the American College of Obstetricians and Gynecologists 1, 3
The American College of Obstetricians and Gynecologists states that no waiting period is required after ICB injection as it does not appear to significantly reduce pain effectiveness 4
ICB has demonstrated reduced pain with both tenaculum placement and IUD insertion, particularly in nulliparous patients, according to the American College of Obstetricians and Gynecologists 1
The American College of Obstetricians and Gynecologists found that ICB with 6 mL of 2% lidocaine has been shown to be more effective than naproxen 550 mg alone in reducing pain during levonorgestrel IUD insertion 3

The American College of Obstetricians and Gynecologists recommends 2% lidocaine as the preferred medication for ICB based on clinical evidence 1, 3
Buffered 1% lidocaine (mixing 2 mL sodium bicarbonate with 18 mL of 1% lidocaine) can reduce injection pain when using PCB, as suggested by the American College of Obstetricians and Gynecologists 5
The American College of Obstetricians and Gynecologists advises that no waiting period is required after ICB/PCB injection before proceeding with IUD insertion 4
The American College of Obstetricians and Gynecologists warns patients about potential self-limiting side effects of intravascular lidocaine, such as numbness of the tongue or tinnitus 2

The American College of Obstetricians and Gynecologists suggests that PCB is particularly helpful for more challenging IUD placements, such as those requiring cervical dilation 5
For failed first attempts at IUD placement, the American College of Obstetricians and Gynecologists recommends considering misoprostol 400 mcg buccally or vaginally 3-4 hours before placement or 200 mcg 10 and 4 hours before placement in addition to ICB/PCB 5
The American College of Obstetricians and Gynecologists found that in nulliparous patients, ICB has demonstrated improved patient experience and reduced pain scores 1

After successful placement, the American College of Obstetricians and Gynecologists recommends having the patient lie supine on the examination table with legs out of footrests for 5 minutes 5
The American College of Obstetricians and Gynecologists advises gradually raising the head of the table to reduce risk of vasovagal episodes 5
The American College of Obstetricians and Gynecologists suggests offering a drink, snack, and/or heating pad for the lower abdomen 5
The American College of Obstetricians and Gynecologists recommends advising the patient to take an NSAID with food on a scheduled basis for the first 24-72 hours postprocedure 5

The American College of Obstetricians and Gynecologists emphasizes the importance of always aspirating before injection to avoid intravascular administration of lidocaine 3
The American College of Obstetricians and Gynecologists monitors for signs of lidocaine toxicity (circumoral numbness, facial tingling, slurred speech, metallic taste) 6
The American College of Obstetricians and Gynecologists notes that misoprostol should be used cautiously and only in cases of failed placement or selected patients with risk factors for failed insertion, as it can increase post-procedure cramping 7