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

Abstract

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 Recently, simple, quick, safe and inexpensive methods such as Pipelle, Vabra and Z-sampler have superceded this technique.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).

Efficacy of Intrauterine Lidocaine Instillation in Reducing Pain during Endometrial Biopsy by Novak

“…We recruited a larger number of participants compared to previous studies and extended the evaluation of postoperative pain to 2 hours after the procedure. This is in contrast to previous studies [ 4 , 6 – 12 ], which measured the patient's pain level during and up to thirty minutes after procedure. The analgesic effect of intrauterine lidocaine was still present at 15 minutes and 2 hours after the procedure.…”

“…Previous studies have investigated the efficacy of intrauterine lidocaine instillation for pain relief during endometrial aspiration. The studies of Kosus et al [ 6 ], Dogan et al [ 7 ], and Guler et al [ 12 ] compared the intrauterine instillation of the lidocaine group to no anesthetic group while Maderak et al [ 10 ] compared intrauterine lidocaine to sterile water during endometrial aspiration. Kosus, Trolice, and Sargin [ 4 , 8 , 11 ] also evaluated the efficacy of intrauterine lidocaine compared to normal saline in a similar fashion to this study.…”

“…All previous studies used disposal plastic endometrial aspirators (Pipelle) [ 4 , 6 – 12 ] while the present study used a metallic endometrial aspirator (Novak). We recruited a larger number of participants compared to previous studies and extended the evaluation of postoperative pain to 2 hours after the procedure.…”

“…It has a rapid onset, short duration of action, low cost, minimal side effects, and good availability [ 3 ]. Recent literature showed that intrauterine lidocaine and bupivacaine instillation were appropriate methods for pain relief during intrauterine procedures [ 4 – 12 ].…”

Effects of lidocaine spray for reducing pain during endometrial aspiration biopsy: A randomized controlled trial

“…2,3 Many anesthetic or analgesic methods have been employed for the control of pain associated with endometrial biopsy with various effectiveness. These include intrauterine infusion of lidocaine [2][3][4][5][6][7][8][9][10] or levobupivacaine solution, 11,12 endocervical application of lidocaine gel, 13,14 paracervical block 7,12,15 and preoperative oral administration of nonsteroidal antiinflammatory drugs (NSAID). 3,[15][16][17][18] Lidocaine spray to the cervix represents a simple and effective pain control measure for many minor gynecological procedures including intrauterine device insertion, 19 firsttrimester surgical abortion, 20 hysteroscopy 21 and loop electrosurgical excision procedures (LEEP) of the cervix.…”