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

Abstract

Abnormal uterine bleeding in women aged 35 years or over is an important clinical sign of many gynecological conditions. The diagnoses of these conditions require the pathological report of the endometrial tissue. Outpatient-based endometrial biopsy is an excellent option compared to standard fractional uterine curettage or hysteroscopy with endometrial biopsy in providing a definite diagnosis for abnormal uterine bleeding as it is less painful and does not require high potency anesthesia. This study evaluates the effect of intrauterine lidocaine on the patient's pain score during endometrial biopsy by the Novak curette. We included patients aged 35 years or more who had abnormal uterine bleeding between December 2016 and March 2018. The study was conducted at Thammasat University Hospital, Pathum Thani, Thailand. 250 patients were randomly allocated to either receive intrauterine lidocaine (study group) or normal saline (control group). Assessment of pain severity was evaluated using a visual analogue scale (VAS) score at 6 time-points, namely, before performing the procedure, when grasping the cervix by the tenaculum, during the intrauterine instillation of lidocaine or normal saline, during the uterine curettage, and then 15 minutes and 2 hours after the procedure. This study showed that there was significant pain reduction in patients who received intrauterine instillation of lidocaine compared to placebo, during uterine curettage, as well as 15 minutes and 2 hours after procedure (p<0.0001). Patient satisfaction was not significantly different between the two groups, while physician satisfaction significantly improved in the lidocaine group. Serious complications were not found during this study. (This research project had been approved for registration at Thai Clinical Trials Registry. TCTR identification number is TCTR20161031003.)

Comparing Transcervical Intrauterine Lidocaine Instillation with Rectal Diclofenac for Pain Relief During Outpatient Hysteroscopy: A Randomized Controlled Trial

“…In concordance with these findings, Mohammadi and colleagues [17] conducted a double-blind randomized controlled trial on 70 nulliparous women with primary infertility undergoing diagnostic hysteroscopy. Subjects were assigned into one of two groups to receive either 100 mg of rectal diclofenac or 5 mL of 2% intrauterine lidocaine.…”

“…This drug is readily absorbed from the alimentary tract and its half time is about one to two hours, and it will quickly dissolve in an environment with a pH higher than five. Diclofenac as one of the most potent NSAID has a few side effects when administered rectally [17] .…”

Methods of pain control during endometrial biopsy: A systematic review and meta‐analysis of randomized controlled trials

“…The size of the included studies ranged from 40 to 308. The countries represented were Turkey (14 studies), 11,13,15,16,[18][19][20]23,24,29,40,[42][43][44] Thailand (five studies), 21,25,26,28,30 USA (three studies), 10,12,27 China (one study), 17 Iran (one study), 14 UK (one study), 22 and Canada (one study). 41 The low-pressure devices were the most common instruments used for endometrial biopsy in the included studies (16 studies).…”

“…41 The low-pressure devices were the most common instruments used for endometrial biopsy in the included studies (16 studies). [10][11][12][13][14][15][16]18,19,23,26,27,[41][42][43][44] For the nine studies that employed high-pressure suction devices, four used Karman cannula, 17,20,24,29 three used Novak suction curette, 21,25,28 one used Vabra aspirator, 22 and one used Endosampler. 30 In one study, 40 the type of instrument was not specified.…”

“…[10][11][12][13][14] Many anesthetic or analgesic methods have been employed during the procedure with various success. These include intrauterine anesthetics infusion, 10,11,[13][14][15][16][17][18][19][20][21] cervical application of anesthetic spray or gel, 12,14,[22][23][24][25][26] paracervical block, 16,18,27 and preoperative oral administration of nonsteroidal anti-inflammatory drugs (NSAID). 11,[27][28][29][30] The aim of this systematic review of randomized controlled trials was to examine the effectiveness of available methods in reducing pain during endometrial biopsy.…”