Anaesthesia during coil insertion remains a matter of practice
A new pilot has reignited the debate, while the national GPs’ working instruction mainly mentions paracetamol or naproxen.
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Some GPs use local anaesthetic when inserting a coil, while the national NHG working instruction recommends paracetamol or naproxen beforehand. A recent pilot on an adapted anaesthetic technique has reignited the debate about pain relief.
According to professional publication DOQ, the pilot was conducted by GPs Tijn van Winden and Valentine Endtz. The average pain score in the pilot was 2 with the anaesthetic studied, compared with 5 to 7 without pain relief. The publication describes the study as promising, but it was a small pilot and not a national guideline.
The current NHG working instruction advises taking 500 milligrams of naproxen one hour before insertion, or 1,000 milligrams of paracetamol if NSAIDs are contraindicated. The instruction also says that the pain experienced can vary considerably and that the GP should maintain contact with the patient during the procedure.
That does not mean local anaesthetic is prohibited. Practice varies according to the GP, available training and assessment of the situation. Moreover, the technique studied is not evidence that every form of anaesthesia has the same effect for every patient or is without risks.
The debate is therefore not only about a medication, but also about information and choice. Patients can ask beforehand what pain relief is possible, what its benefits and limitations are, and when referral to a gynaecologist may be appropriate.
The NHG guideline leads the standard procedure, but guidelines can be amended when new research proves sufficiently reliable and applicable. Whether the pilot warrants an amendment requires further assessment. Anyone considering a coil can discuss the options with their own healthcare provider; this article is not personal treatment advice.
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One story, several perspectives
What is established
- A small pilot reported lower average pain scores with an anaesthetic technique under investigation.
- The NHG working instruction mentions naproxen or paracetamol beforehand and emphasises consultation during the procedure.
- The final guideline status of the technique under investigation has not been established in the sources consulted.
Left
Arguments Emphasises that patients should be able to discuss pain seriously and that proven or promising pain relief should be readily available.
Values Equal access, bodily autonomy and patient-centred care.
Consequences Fears that differences between practices will lead to unequal care and that pain will be underestimated.
Centre
Arguments Wants new techniques to be carefully assessed for effectiveness, safety, training and feasibility before being incorporated widely into the guideline.
Values Evidence-based care, professional standards and informed choice.
Consequences Emphasises that both insufficient and overly rapid introduction of pain-management policies can harm patients.
Right
Arguments Emphasises GPs’ professional discretion and warns against additional protocols, costs and liability risks without sufficient evidence.
Values Medical autonomy, responsibility and efficiency.
Consequences Fears that a general obligation would place a heavier burden on primary care and would not suit every patient.
The perspectives describe how these political currents typically approach the subject; the newsroom takes no position on which perspective is right.
Fact-check Approved · Nour Haddad — AI agent
This check was carried out by AI: every claim was re-tested against the sources. Even an approved article can contain errors — stay critical.
The text clearly distinguishes between a small pilot and the existing NHG working instruction. No medical effectiveness or personal advice is presented as established fact.
- confirmed The pilot reported an average pain score of 2 with anaesthesia, compared with 5 to 7 without pain relief. — DOQ reports this outcome. source
- confirmed The NHG working instruction advises taking 500 milligrams of naproxen or 1,000 milligrams of paracetamol beforehand. — This is stated literally in the publicly available NHG working instruction. source
- confirmed The pilot is not a national guideline. — The source describes a pilot; the NHG working instruction remains the national working instruction consulted. source
- uncertain Local anaesthetic is not identified as prohibited in the sources consulted. — The sources describe options and guideline advice, but do not provide an exhaustive legal assessment. source
Editor's note
The pilot results and the current NHG working instruction can be verified. The pilot is small, and the final revision of the guideline was not published in the sources consulted.Sources
- ‘Ons doel: spiraalplaatsen met verdoving in de richtlijn’ — DOQ
- Werkbeschrijving Spiraal inbrengen — Nederlands Huisartsen Genootschap
- Herziening pijnbestrijding NHG-Standaard Anticonceptie — Koninklijke Nederlandse Organisatie van Verloskundigen
More on this in Dutch media
- AD — „spiraal anticonceptie”
- de Volkskrant — „spiraal anticonceptie”
- RTL Nieuws — „spiraal anticonceptie”