A randomised double‐blind placebo‐controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy

Lau, W. S.; Tam, Wing Hung; Lo, Wai Kit; Yuen, Pong Mo

doi:10.1111/j.1471-0528.2000.tb13301.x

Cited by 76 publications

(34 citation statements)

References 12 publications

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“…Although these studies are different from ours in terms of material and method, they are significant as they showed that intrauterine anesthesia decreased pain in many gynecologic procedures. A limited number of studies on intrauterine topical anesthesia is available in literature and in most of these studies, the effectiveness of intrauterine anesthesia was investigated either in hysteroscopy or in hysteroscopy combined with endometrial biopsy (5,(8)(9)(10)17). Endometrial biopsy taken during hysteroscopy is more invasive and potentially more disturbing than only endometrial biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have investigated the use of local anesthetics (i.e., lidocaine, mepivacaine) to lessen the pain experienced during minor gynecological procedures such as endometrial biopsy and office hysteroscopy. Most, but not all, of these studies reported reduced pain during the procedure (8)(9)(10). The main objective of the present study was to compare the effectiveness of paracervical block, intrauterine lidocaine and oral etodolac in decreasing pain caused by endometrial sampling.…”

Section: Sonuçmentioning

confidence: 99%

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Comparison of the efficacy of intrauterine lidocaine, paracervical block and oral etodolac for decreasing pain in endometrial biopsy

Güler¹,

Şahin²,

Kucukaydin³

et al. 2010

J Turkish German Gynecol Assoc

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Objective:To compare the effectiveness of paracervical block, intrauterine lidocaine and oral etodolac in decreasing the pain caused by pipelle endometrial sampling. A secondary goal of this study was to determine the adverse effects and compare possible effects of these methods on pulse and blood pressure. Material and Methods:The study was performed between April 2006 and October 2006 in the Obstetrics and Gynecology Department of Van Yüzüncü Yıl University Research Hospital. One-hundred twenty patients were randomized into four groups: 1. Group: Paracervical block was performed with 3 ml 2% prilocaine solution. 2. Group: Five ml of 2% lidocaine solution was instilled through the endocervix into the uterine cavity. 3. Group: Subjects received 400 mg oral etodolac tablet 1-1.5 hour before the procedure. 4. Group: No method of anesthesia was used in the control group. Endometrial sampling was performed with pipelle. Severity of pain during the procedure was scored by the subjects according to the "6-point Verbal Rating Scale (VRS)". Blood pressure and pulse rate were measured before, during and 30 minutes after the procedure.Results: Pain scores in intrauterine lidocaine group (2 nd group) were found statistically significantly lower than the other three groups (p<0.05). Conclusion: Intrauterine lidocaine anesthesia technique decreasespain in endometrial sampling with pipelle more efficiently than paracervical block or oral etodolac. While indication of menorrhagia and endometrial thickness more than 5 mm increased pain scores, intrauterine lidocaine application or paracervical block decreased the scores significantly (p<0.05 Abstract Özet Original Investigation 178Endometrial sampling is a diagnostic tool that is frequently applied in outpatient clinics for many disorders, including abnormal uterine bleeding, abnormal cytology, postmenopausal bleeding, hormone therapy monitoring and infertility. Today, although sonographic evaluation of the endometrium is the first step, pathological examination is still "the gold standard" in the diagnostic pathway. Traditionally, the standard method of assessing the endometrium has been dilatation of the cervix and curettage (D&C) of the uterine cavity. Recently, simple, quick, safe and inexpensive methods such as Pipelle, Vabra and Z-sampler have superceded this technique. Pipelle is the most popular of these sampling devices (1, 2). Although pipelle is known to be painless or to cause less pain than conventional methods of endometrial sampling, nearly half of the patients experience moderate-to-severe pain during the procedure (3). Nevertheless, there are only a few studies that have evaluated possible methods of pain-relief during endometrial biopsy using a pipelle (4).

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Section: Discussionmentioning

confidence: 99%

Section: Sonuçmentioning

confidence: 99%

Comparison of the efficacy of intrauterine lidocaine, paracervical block and oral etodolac for decreasing pain in endometrial biopsy

Güler¹,

Şahin²,

Kucukaydin³

et al. 2010

J Turkish German Gynecol Assoc

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show abstract

“…Two relatively small randomized double-blind studies using mepivacaine injected through the cervix prior to hysteroscopy or endometrial sampling found a beneficial effect [7,8]. Using lidocaine 2% prior to endometrial biopsy, Hui et al [9] also reported lower pain scores in the treated group, whereas both Lau et al [10] (90 patients) and Wong et al [6] (500 women) did not find any improvement in the pain experienced during hysteroscopy or endometrial sampling after lidocaine instillation (all three studies [6,9,10] were randomized and double-blind). The only randomized study using intrauterine lidocaine 2% gel [11] prior to Vabra endometrial sampling in 308 patients did not show any pain reduction in the lidocaine group.…”

Section: Discussionmentioning

confidence: 99%

Lidocaine Does Not Reduce Pain Perception during Gel Instillation Sonography or Subsequent Office Hysteroscopy: Results of a Randomized Trial

Bosch

Schoubroeck²,

Daemen³

et al. 2010

Gynecol Obstet Invest

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Background: To evaluate if the addition of lidocaine to the gel used for gel infusion sonohysterography (GIS) reduces pain experienced during GIS or subsequent hysteroscopy. Methods: A total of 142 consecutive patients were randomized using computer-generated random integers. In 79 patients, GIS was performed with a gel containing lidocaine (Instillagel®) and in 63 patients the gel did not contain lidocaine (Endosgel®). Immediately after GIS, 132 patients (94%) underwent office hysteroscopy. The women were asked to fill in a questionnaire including a 100-mm visual analogue scale (VAS) score after each examination. Results: The mean age (SD) was 50.8 (12.1) years; 58.5% were premenopausal and 15.6% were nulliparous. The median (interquartile range (IR)) VAS score during GIS for all women was 6 (19.5): 8 (21) for the lidocaine group versus 5 (18.2) for those who received gel without lidocaine. The median (IR) VAS scores during hysteroscopy in the total group, the Instillagel group and the Endosgel group were 15.5 (43.2), 24 (35) and 9 (52), respectively. None of the differences were statistically significant. Conclusion: The addition of lidocaine to the gel used either for GIS or prior to office hysteroscopy does not reduce the procedure-related pain.

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“…No difference was found in pain scores between the lignocaine group and the placebo group. 9 However, the instillation of the study fluids was through an angiocatheter inserted only up to the internal os of cervix and it was not mentioned whether any attempt was made to keep the study fluid inside the uterine cavity to allow the local anaesthetic to act. Furthermore, hysteroscopy was performed before endometrial sampling.…”

Section: Discussionmentioning

confidence: 99%

General gynaecology: Intrauterine lignocaine as an anaesthetic during endometrial sampling: a randomised double‐blind controlled trial

Hui¹,

Lee²,

Ong³

et al. 2005

BJOG

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Objective To evaluate the effectiveness of intrauterine lignocaine as an anaesthetic during endometrial sampling.Design Prospective, randomised, double-blind, placebo-controlled trial.Setting Outpatient gynaecological minor operation unit in a public hospital.Population Two hundred premenopausal women scheduled for endometrial sampling because of abnormal uterine bleeding.Methods Transcervical intrauterine instillation of 5 mL of 2% lignocaine or 5 mL of normal saline before performing endometrial sampling with vacuum aspirator.Main outcome measures Evaluation of pain associated with the procedure using a visual analogue scale.Results The use of intrauterine lignocaine reduced pain during suction curettage in endometrial sampling.Conclusions Transcervical instillation of lignocaine reduced pain during endometrial sampling.

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A randomised double‐blind placebo‐controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy

Cited by 76 publications

References 12 publications

Comparison of the efficacy of intrauterine lidocaine, paracervical block and oral etodolac for decreasing pain in endometrial biopsy

Comparison of the efficacy of intrauterine lidocaine, paracervical block and oral etodolac for decreasing pain in endometrial biopsy

Lidocaine Does Not Reduce Pain Perception during Gel Instillation Sonography or Subsequent Office Hysteroscopy: Results of a Randomized Trial

General gynaecology: Intrauterine lignocaine as an anaesthetic during endometrial sampling: a randomised double‐blind controlled trial

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