Use of Paracervical Blocks for Patients Who Undergo Intrauterine Device Insertion

Importance: Paracervical blocks can reduce pain during intrauterine device (IUD) insertions, but the extent and context in which they are used in practice are unclear. Objective: To evaluate paracervical block use during IUD insertions in an academic health system. Design, Setting, and Participants: This retrospective cross-sectional time-series study was performed at the University of California, San Francisco (UCSF), academic health care system using electronic health record data. Participants included individuals who underwent IUD insertions between July 2, 2012, and August 16, 2024. Data were analyzed from October 2023 to April 2025. Exposure: Clinic-, clinician-, and patient-level variables. Main Outcomes and Measures: Paracervical block receipt was determined from clinical notes. Associations of paracervical block receipt with variables at the clinic, clinician, and patient levels were estimated with multilevel models. The role of clinic specialty (pediatrics or adolescent medicine vs all other specialties) in accounting for the association of age less than 18 years with paracervical block receipt was evaluated using causal mediation analysis. Results: Among 13 702 IUD insertions (median patient age, 33.16 [IQR, 27.62-37.73] years), 11 713 (85.5%) took place within obstetrics and gynecology (OB-GYN) specialty clinics and almost half (6049 [44.1%]) occurred between a patient-clinician dyad who had never seen each other before. Overall, 5311 insertions (38.8%) included a paracervical block. Paracervical blocks were less frequently used in non-OB-GYN specialties (odds ratio [OR], 0.01; 95% CI, 0.001-0.07) and appointments scheduled for less than 30 minutes (OR, 0.77; 95% CI, 0.66-0.90) and more frequently used when the patient-clinician dyad had a prior visit together (OR, 1.27; 95% CI, 1.09-1.48). A lower proportion of patients aged less than 18 years (84 of 347 [24.2%]) compared with adults (5227 of 135 55 [38.6%]) received a paracervical block, an association mediated by the former population more often receiving care in pediatrics and adolescent medicine clinics (total effect risk difference [RD], -0.11 [95% CI, -0.19 to -0.03]; indirect effect RD, -0.22 [95% CI, -0.26 to -0.18]). Latine patients (OR, 0.77; 95% CI, 0.64-0.94 [reference group, non-Hispanic White patients]) and patients with a preferred language besides English (OR, 0.63; 95% CI, 0.41-0.96) had lower odds of receiving a paracervical block during IUD insertion. Conclusions and Relevance: In this cross-sectional time series study of IUD insertion procedures in a large academic health system, Latine ethnicity, non-English language preference, no prior patient-clinician visit together, and shorter appointment length were associated with lower odds of receiving paracervical blocks. Potential conduits for increasing paracervical block access include training opportunities, equitable clinic policies, and sufficient appointment duration.