Following the correspondence on the subject in this Journal,1 2 I write to support the position that women should be offered the option of local anaesthetic for intrauterine device (IUD) fittings and allowed to make a guided but informed decision.

I have been offering intracervical anaesthesia to women since the introduction of the levonorgestrel intrauterine system in 1995. I use dental cartridges containing prilocaine 3% and felypressin 0.03 IU/ml (branded as Citanest® with Octapressin). This is delivered via a breech loading dental syringe with a 27 G 35 mm screw fit needle. This anaesthetic offers rapid onset and low cardiovascular toxicity, and I can report no episodes of true tachyarrhythmia or perceived palpitations over this time. I have used plain mepivacaine 3% when the preferred preparation has been unavailable and this appears to be less well tolerated. I have never used lidocaine but would be instinctively …