FeatureLidocaine spray and outpatient hysteroscopy: randomized placebo-controlled trial
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Materials and methods
One hundred twenty-one consecutive women who had diagnostic hysteroscopy for abnormal uterine bleeding or infertility at the Service de Gynécologie, Hôpital Hôtel-Dieu de Paris entered the study after giving informed consent. Inclusion criteria were diagnostic hysteroscopy and subject approval after a detailed explanation. Exclusion criteria were menorrhagia at the time of the procedure, known sensitivity to lidocaine, epilepsy, significantly impaired respiratory or cardiac conduction
Results
One hundred twenty-one women were enrolled. In the placebo group, two women did not fill out questionnaires properly and were excluded. In one case in the anesthetic group, the diagnostic hysteroscopy was not done because of cervical stenosis. Thus, the study included 118 women (62 in the anesthetic group and 56 in the placebo group). Subject characteristics are given in Table 1. The mean ± SD ages of women in the study and the control groups were 49.6 ± 12.5 and 49.4 ± 10.1 years,
Discussion
Our study showed that aerosol spray lidocaine on the cervix reduced pain and discomfort after diagnostic hysteroscopy. Previous reports on diagnostic hysteroscopy with intracervical,7 paracervical,8, 13 or topical uterine anesthesia10, 11, 14 nerve blocks did not provide adequate evidence that local anesthesia was efficacious for reducing pain. Few randomized controlled trials were done to evaluate efficacy of local anesthesia. Broadbent et al7 found no advantage in using intracervical
References (16)
- et al.
State-of-the-art flexible hysteroscopy for office gynecologic evaluation
J Am Assoc Gynecol Laparosc
(1995) - et al.
The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy
Fertil Steril
(1995) - et al.
Paracervical anesthesia for outpatient hysteroscopy
Fertil Steril
(1994) Panoramic hysteroscopy with directed biopsy versus dilatation and curettage for accurate diagnosis
J Reprod Med
(1984)- et al.
Office hysteroscopy and suction curettageCan we eliminate the hospital diagnostic dilatation and curettage?
Am J Obstet Gynecol
(1985) - et al.
A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage
Am J Obstet Gynecol
(1988) Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding. The value of a negative hysteroscopy view
Obstet Gynecol
(1989)- et al.
Acceptability and pain of outpatient hysteroscopy
J Am Assoc Gynecol Laparosc
(2000)
Cited by (58)
Local anaesthesia for office hysteroscopy: A systematic review & meta-analysis
2020, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Underreporting of the randomization process [13], poor clarity of whether pain scores were included where hysteroscopy failed [12,17], participant awareness of the intervention received [11,12,39,43,46], significant differences in methodology between randomised groups [24] and unsatisfactory reporting of results [13,14,17,22–25] were the significant sources of bias amongst included studies. Meta-analysis of 20 studies [7,11,12,14,30–36,38–41,43,45–47,49], including 2610 patients, showed that administration of local anaesthesia achieved a statistically significant reduction in pain during office hysteroscopy; standard mean difference (SMD) -0.57, 95 % CI -0.79 to -0.34 (Figs. 3 & 4 ). A significant reduction in mean pain during office hysteroscopy remained when data aggregation was restricted to studies with lower risk of bias (Fig. 5).
Failed diagnostic hysteroscopy: Analysis of 62 cases
2020, European Journal of Obstetrics and Gynecology and Reproductive BiologyOffice Operative Hysteroscopy: An Update
2018, Journal of Minimally Invasive GynecologyCitation Excerpt :Other options for local analgesia include lidocaine sprays, gels, and creams that can be applied to the cervix when a speculum is used. These topical anesthetics can decrease the pain associated with tenaculum placement, but studies have shown inconsistent wait times before the procedure can be started [30,31]. Moreover, anatomically, these topical methods can affect only superficial pain receptors and do not address pain arising from uterine distention [29].
Office Diagnostic and Operative Hysteroscopy Using Local Anesthesia Only: An Analysis of Patient Reported Pain and Other Procedural Outcomes
2014, Journal of Minimally Invasive GynecologyEvaluation of pain in office hysteroscopy with prior analgesic medication: A prospective randomized study
2014, European Journal of Obstetrics and Gynecology and Reproductive BiologyHysteroscopy: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians
2014, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :The conflicting results of various studies do not appear to reveal any advantage in applying lidocaine or lignocaine in the form of a spray or a gel, prior to a diagnostic hysteroscopy [57–63]. Only the trial reported by Soriano et al., dealing with flexible hysteroscopies, appeared to indicate an advantage (LE2) [59]. Meta-analyses are not in favour of the use of this type of topically applied local anaesthesia (LE2) [57–63].