The efficacy of local anesthetics in pain relief during colposcopic-guided biopsy: A systematic review and meta-analysis of randomized controlled trials

Mattar, Omar Mohamed; Samy, Ahmed; Shehata, Mohamed; Ibrahim, Ahmed M.; Abdelaziz, Ahmed; Abdelazeim, Nesrine; Elzemrany, Amal A.; Kasem, Shiref A.; Ros, Mohamed Hassan; Hamad, Linda Y.; Taher, Ayman; El-Sharkawy, Mohamed; Mahmoud, Mohammad; Abbas, Ahmed M.

doi:10.1016/j.ejogrb.2019.04.047

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…A systematic review and meta-analysis by Mattar et al in 2019 on the use of local anesthetic for pain relief during colposcopic-guided biopsy included 11 randomized controlled trials. They showed that while local anesthetic reduced pain with biopsy, there was no significant improvement in post-procedural pain, pain on endocervical curettage, pain expectancy or overall pain scores [ 34 ]. They concluded that at present there is insufficient evidence to recommend local anesthetics for routine colposcopy exams and cervical biopsies.…”

Section: Resultsmentioning

confidence: 99%

2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia

Willows,

Selk,

Auclair

et al. 2023

Current Oncology

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This guideline provides evidence-based guidance on the risk-based management of cervical dysplasia in the colposcopy setting in the context of primary HPV-based screening and HPV testing in colposcopy. Colposcopy management of special populations is also discussed. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC) and the Canadian Partnership Against Cancer (CPAC). The literature informing these guidelines was obtained through a systematic review of the relevant literature via a multi-step search process led by information specialists. The literature was reviewed up to June 2021 with manual searches of relevant national guidelines and more recent publications. Quality of the evidence and strength of recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include gynecologists, colposcopists, screening programs and healthcare facilities. Implementation of the recommendations is intended to promote equitable and standardized care for all people undergoing colposcopy in Canada. The risk-based approach aims to improve personalized care and reduce over-/under-treatment in colposcopy.

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Section: Resultsmentioning

confidence: 99%

2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia

Willows,

Selk,

Auclair

et al. 2023

Current Oncology

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“…Curettage is performed with a Kevorkian-Younge curette, ideally under colposcopic guidance, either using an in-and-out motion to use the distal blade or a rotating motion to use the lateral blades, applying a corkscrew motion to ensure comprehensive sampling of the full circumference of the canal 5 . A 2019 systematic review and meta-analysis of 11 trials failed to show an impact of local anesthesia on pain from ECC, 6 so use of an anesthetic is not recommended. Regardless of technique, the sample should consist of both tissue removed on the curette along with tissue, mucus, and blood collected after curettage with forceps or brush to minimize risk of insufficient sampling 7 .…”

Section: Techniquementioning

confidence: 99%

Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy

Massad

Perkins

Naresh

et al. 2022

J Low Genit Tract Dis

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ObjectiveThe most recent guidelines for colposcopy practice in the United States, the 2017 Colposcopy Standards Consensus Guidelines, did not include recommendations for endocervical curettage (ECC). This document provides updated guidelines for use of ECC among patients referred for colposcopy.MethodsConsensus guidelines for the use of ECC were developed in 2012. To update these guidelines in concordance with the 2017 Colposcopy Standards process, an expert workgroup was convened in 2021. Literature had been previously reviewed through 2011, before the 2012 guideline. Literature from the years 2012–2021 and data from the NCI Biopsy study were reviewed, focusing on the additional yield of ECC.ResultsEndocervical curettage is recommended for patients with high-grade cytology, human papillomavirus 16/18 infection, positive results on dual staining for p16/Ki67, for those previously treated for known or suspected cervical precancer or considering observation of cervical intraepithelial neoplasia grade 2, and when the squamocolumnar junction is not fully visualized at colposcopy. Endocervical curettage is preferred for all patients aged older than 40 years. Endocervical curettage is acceptable for all nonpregnant patients undergoing colposcopy but may be omitted when a subsequent excisional procedure is planned, the endocervical canal does not admit a sampling device, or in nulliparous patients aged younger than 30 years, with cytology reported as atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion regardless of whether the squamocolumnar junction is fully visualized. Endocervical curettage is unacceptable in pregnancy.ConclusionsThese guidelines for ECC add to the 2017 consensus recommendations for colposcopy practice in the United States.

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“…Systematic reviews reported that local cervical anesthesia administration has no statistically significant outcomes in pelvic pain reduction during colposcopy (Mattar et al, 2019). Whereas some oral analgesias were found to significantly decrease pain (Darweesh et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Oral Etoricoxib in Pain Control During Colposcopy-Directed Cervical Biopsy: A Randomized Control Trial

Sivapornpan,

Punyashthira,

Chantawong

et al. 2023

Asian Pac J Cancer Prev

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Objective: To investigate the effectiveness and safety of oral etoricoxib administration before colposcopic procedure for pain relief during and after colposcopy. Methods: A prospective double-blind, randomized controlled trial was conducted at the colposcopy unit of Thammasat University Hospital, Thailand from August 2022 to January 2023. The participants were women undergoing colposcopy. They were allocated into two groups: etoricoxib group and control group. Thirty minutes prior to colposcopy, the participants received etoricoxib or placebo tablet. A numerical rating scale was used to evaluate pain upon speculum insertion, 3% acetic acid application, directed cervical biopsy (CDB), endocervical curettage (ECC), and 10 minutes and 24 hours after colposcopy. Result: One hundred and ten women were recruited and were divided equally into study and control groups. The mean age of participants was 42.6 years old. One-fourth of cases (29/110) had cervical intraepithelial neoplasia grade 2 or more histology. Subjects in etoricoxib group had less median pain scores during CDB, ECC, and 10-minute and 24-hour post procedure than the control group with statistical significance. Both groups had comparable side effects. Conclusion: Administration of oral etoricoxib 30 minutes before colposcopy could reduce pain during and up to 24-hour post colposcopy with minimal side effects.

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The efficacy of local anesthetics in pain relief during colposcopic-guided biopsy: A systematic review and meta-analysis of randomized controlled trials

Cited by 6 publications

References 15 publications

2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia

2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia

Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy

The Efficacy of Oral Etoricoxib in Pain Control During Colposcopy-Directed Cervical Biopsy: A Randomized Control Trial

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