Pain at vulvar biopsy is not reduced by addition of buffer to lidocaine

Vulvar skin is very sensitive and so an anaesthetic is recommended to minimise pain during biopsy of vulvar lesions. However, local anaesthetic injections themselves can be painful. Clinical guidelines often suggest considering adding a ‘buffer’ to a local anaesthetic to minimise pain on injection, yet the evidence base for this is minimal. This randomised controlled trial (RCT) compared plain lidocaine 1% with lidocaine 1% plus sodium bicarbonate. The trial was powered to show a difference in 15 mm on a 100 mm visual analogue scale; however, no difference between study groups was detected. Topical lidocaine cream or gel may prove more effective as this would remove any injection pain and anxiety related to the use of a needle.

Obstet Gynecol 2020;135(3):609-614.

Fresh embryo transfer at IVF is associated with greater incidence of VTE than frozen-thawed transfers

Typically, during in vitro fertilisation (IVF) an embryo is transferred following ovarian stimulation and egg collection (a ‘fresh’ embryo transfer). Any remaining embryos are frozen, to be thawed and transferred at a later date if desired. IVF is known to increase the risk of venous thromboembolism (VTE) during pregnancy; however, this Swedish registry study has demonstrated that fresh embryo …