Objective: To evaluate the safety, feasibility and efficacy of a hysteroscopic local anaesthetic intrauterine cornual block (ICOB) on women's perception of pain during outpatient Thermachoice endometrial ablation (TEA).
Study design: Pre-menopausal women with heavy menstrual bleeding undergoing TEA were included in the study. The intervention used, ICOB, was a hysteroscopic injection of local anaesthetic into the myometrium just medial to each tubal ostium. The women also had a traditional direct cervical block (DCB). We measured the acceptability of ICOB and the pain score (visual analogue score scale) immediately after the procedure.
Results: We treated 30 patients (mean age 41 years, SD 6; BMI 29±7) between January 2012 and December 2012. All patients had a successful ICOB block and found TEA with ICOB acceptable. The mean VAS score was 3.5±2.7, which was two points lower compared to our earlier prospective cohort of patients undergoing TEA with only a DCB (mean 5.8±2.7, n=102). No serious complications occurred during the procedure or postoperatively. Three patients experienced a vasovagal response which resolved spontaneously.
Conclusion: ICOB with DCB is a safe, feasible and efficacious method of pain control during TEA. There is however a need to evaluate efficacy of ICOB in a randomised placebo controlled trial.
Keywords: Direct cervical block; Endometrial ablation; Intrauterine cornual block; Local anaesthesia; Thermachoice ablation.
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