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Lidocaine spray and outpatient hysteroscopy: randomized placebo-controlled trial

https://doi.org/10.1016/S0029-7844(00)00984-4Get rights and content

Abstract

Objective: To assess the efficacy of lidocaine spray during outpatient hysteroscopy for reducing procedure-related pain and to identify risk factors for discomfort.

Methods: One hundred twenty-one women were assigned randomly to have application of lidocaine spray or placebo to the uterine cervix during outpatient hysteroscopy. The main outcome measure was pain during hysteroscopy, assessed on a visual analog scale.

Results: There was no statistically significant difference between study and control groups in mean age, rate of nulliparity, postmenopausal state, need for cervical dilation, or percentage of women who used hormone replacement therapy. Indications for diagnostic hysteroscopy were similar between groups. Women in the lidocaine group had statistically significantly less pain during the procedure than women in the placebo group (2.2 ± 1.9 and 3.7 ± 2.5, respectively; P < .001). Women with abnormal uterine findings (submucous myoma, endometrial polyps, or intrauterine adhesions) had significantly higher pain scores than women with normal cavities (2.2 ± 1.9 and 3.2 ± 2.4, respectively; P < .002). Aerosol anesthesia and normal uterine findings were independently associated with less pain. No procedure had to be abandoned because of excessive pain or complications, and no women required hospitalization.

Conclusion: Women treated with lidocaine spray had significantly less pain. Uterine cavity abnormality might be associated with a higher degree of pain during hysteroscopy.

Section snippets

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

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