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Nitrous oxide for pain management of intrauterine device insertion in nulliparous women

Shannon Carr, University of New Mexico, 2013

Project abstract

Background: The intrauterine device (IUD) is one of the most effective forms of contraception available in the US. The rate of IUD uptake among nulliparous women is unknown; IUDs are underutilized among teens (3.6%), many of whom are nulliparous. Pain, and/or fear of pain, associated with IUD insertion may be a barrier to uptake among nulliparous women.

Objective: To compare mean patient-perceived IUD insertion pain measured by a validated visual analog scale (VAS) in nulliparous women randomized to nitrous oxide (NO) versus oxygen (placebo). A secondary outcome is patient satisfaction with pain management, measured on a Likert scale, between the two groups.

Methods: This single blinded randomized controlled trial will be conducted at the Center for Reproductive Health at the University of New Mexico. Eligible nulliparous women will be randomized to receive NO or oxygen during IUD insertion. Following IUD insertion, participants will report insertion pain scores measured on a 100 mm-VAS, and overall satisfaction measured on a 4-point Likert scale. A total of 40 women per study arm are required to achieve a minimal clinically significant difference in mean pain scores of 15 mm; β = 80%, α = 0.05.

Potential significance of results: We hypothesize that NO administration will result in a significantly lower mean pain score compared with placebo, and that the NO group will report significantly higher mean satisfaction scores compared with the placebo group. If effective, this study may lead to more widespread use of NO for procedural pain management and to future research on the use of nitrous oxide for other office-based gynecologic procedures.

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