| Lidocaine 2.5%-prilocaine 2.5% cream16 | 5 g applied to the ectocervix 5–7 minutes before insertion | See https://www.instagram.com/reel/DCr1Dkzq0bO/ for alternative tampon application technique |
| Lidocaine 10% spray16 | 4 puffs (40 mg) applied to the ectocervix 3 minutes before insertion | — |
| Lidocaine 1% without epinephrine16 | 10–20 mL total (injected to approximately 1–2 cm depth); 1 mL at tenaculum site before placement and then remaining at 2, 4, 8, and 10 o’clock, or alternatively at 4 and 8 o’clock | See https://www.innovating-education.org/2018/05/larc-insertion-managing-pain-with-iud-insertion for video demonstration |
| Naproxen16,17 | 550 mg orally 1 hour before insertion; may repeat after 12 hours if needed for persistent cramping | — |
| Tramadol16 | 50 mg orally 1 hour before insertion | — |
| Hydrocodone-acetaminophen18 | 5–10 mg orally 30 minutes before insertion | Light sedation; ride home required after procedure; informed consent should be obtained before administration; evidence for use with intrauterine device insertion is lacking |
| Lorazepam18 | 1 mg orally 30 minutes before insertion | Light sedation; ride home required after procedure; informed consent should be obtained before administration; considered for patients with severe preprocedure anxiety |
| Fentanyl and midazolam10 | Typical initial intravenous doses: 100 mcg fentanyl and 2 mg midazolam; typical maximum intravenous doses: 250 mcg fentanyl and 5 mg midazolam; vital signs and sedation level should be monitored | Moderate sedation; ride home required after procedure; may require referral |
