Randomized Trial of Paracervical Block With Endometrial Biopsy

Carroll, C Shannon; Hines, Randall S.; Haddad, Ghassan; Robinette, Lynda; May, Warren; Cowan, Bryan D.

doi:10.1097/01.spv.0000159923.48505.69

Cited by 6 publications

(11 citation statements)

References 5 publications

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“…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).…”

Section: Study Selectionmentioning

confidence: 99%

“…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.…”

Section: Study Selectionmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

Charoenkwan

Nantasupha

2019

J of Obstet and Gynaecol

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Aim To review effectiveness of methods for reducing pain during endometrial biopsy. Methods PubMed, Scopus, Cochrane Central Register of Controlled Trials and https://ClinicalTrials.gov databases were searched for randomized controlled trials that examined effectiveness of pain control methods for endometrial biopsy. Risk of bias was assessed from sequence generation, allocation concealment, blinding, incomplete outcome data and selective outcome reporting. Heterogeneity was examined from forest plot, statistical tests of homogeneity, and I2 statistic. For meta‐analysis of pain scores, weighted mean difference with 95% confidence interval (CI) were estimated. Results Twenty‐six studies were included in the review. Marginally significant reduction in the pain score during the procedure in participants with intrauterine lidocaine relative to control was observed (mean difference [MD] −1.31, 95% confidence interval [CI] −2.70 to 0.09, P = 0.07). Subgroup analysis showed that in studies that used low‐pressure suction devices, intrauterine lidocaine was associated with statistically significant reduction in pain during the procedure (MD −2.22, 95% CI −3.72 to −0.73, P = 0.004). There was a significantly lower pain score during biopsy in the anesthetic spray group compared to control (MD −0.96, 95% CI −1.53 to −0.39, P = 0.001). Significant heterogeneity on types of intervention and outcome measures among studies that examined paracervical block and nonsteroidal anti‐inflammatory drugs (NSAID) was observed. However, paracervical block and NSAID were associated with significant pain reduction compared to placebo in most of the related studies. Conclusion Intrauterine anesthetics, anesthetic cervical spray, paracervical block and oral NSAID provide effective pain control during endometrial biopsy.

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Charoenkwan

Nantasupha

2019

J of Obstet and Gynaecol

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Piyawetchakarn

Charoenkwan

2019

J of Obstet and Gynaecol

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Aim To examine the effect of lidocaine spray for reducing pain during endometrial aspiration biopsy by comparing it with placebo and no intervention. Methods Women undergoing endometrial aspiration biopsy from March 2017 to January 2018 were invited to participate. The participants were randomly assigned into three groups. In group 1 (lidocaine spray), eight puffs (80 mg, 10 mg/puff, 0.8 mL) of 10% lidocaine spray was applied thoroughly to the cervix, 3 min before starting the procedure. For group 2 (placebo spray), 0.8 mL of normal saline spray was applied to the cervix, 3 min before starting the procedure. For group 3 (no intervention), no anesthesia was given. The patients rated their pain according to a 10‐cm visual analog scale at different points including baseline, immediately after the procedure (biopsy pain), and 10 min after the procedure. The 10‐cm visual analog scale on satisfaction was also rated before hospital discharge. Comparison of continuous variables was made by using Kruskal–Wallis test. Chi squared test was used for comparison of categorical variables. Results Two hundred and forty patients (80 in each group) participated. The mean baseline, biopsy and postprocedural pain scores were not significantly different among the study groups. Similarly, the mean difference between the biopsy and the baseline pain scores were comparable among the groups. In addition, there was no difference on the satisfaction scores among the groups. Conclusion Lidocaine spray applied to the cervix is not effective for reducing pain associated with pipelle endometrial aspiration biopsy.

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“…There is controversy in literature regarding effectiveness of paracervical block in the management of procedural pain. [123] Renner et al ., however, have shown that paracervical block, often used for daycare procedures, reduces pain of minor gynecological surgeries, including dilation pains. [4]…”

Section: Introductionmentioning

confidence: 99%

Deep sedation or paracervical block for daycare gynecological procedures: A prospective, comparative study

Sahay

Agarwal

Bara

et al. 2019

Gynecol Minim Invasive Ther

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Context:Many minor gynecological procedures are done for diagnostic and therapeutic reasons. A balance has to be struck between ability to discharge a patient at the earliest with minimum procedure-related discomfort to ensure patient safety as well as satisfaction.Aim:This prospective randomized study was designed to compare deep sedation versus paracervical block for minor gynecological surgeries comparing the time to discharge readiness, pain after the procedure, and overall patient satisfaction.Setting and Design:This prospective randomized comparative study was conducted at a tertiary level hospital after institutional ethics committee approval and registry of trial at CTRI (India).Methods:Seventy young women underwent minor gynecological procedures under these two modes of anesthesia. Time to discharge readiness from hospital to home was assessed using modified postanesthesia discharge score system (PADSS). Pain after procedure as well as patient satisfaction was evaluated. Patients were also asked whether they would recommend the same anesthetic technique for the procedure in the future. Answers were noted on a Likert scale.Results:Patients were ready to be discharged faster in deep sedation group compared to paracervical block group based upon modified PADSS score (1 h 9.6 min vs. 1 h 18 min) (P = 0.005). Pain in the perioperative period was analyzed using repeated-measures ANOVA and found to be significantly lesser in deep sedation group when considered till 80 min after surgery. The mean satisfaction score in patients who underwent deep sedation was 91.24 (standard deviation [SD] 2.8) compared to patients given paracervical block which was low at 64.67 (SD 15.8). All patients given deep sedation were ready to recommend the anesthesia technique as compared to only 53.3% of patients who were given paracervical block.Conclusions:Deep sedation may be preferred over paracervical block for daycare minor gynecological procedures.

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Randomized Trial of Paracervical Block With Endometrial Biopsy

Cited by 6 publications

References 5 publications

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

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

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

Deep sedation or paracervical block for daycare gynecological procedures: A prospective, comparative study

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