Transcervical intrauterine levobupivacaine infusion or paracervical block for pain control during endometrial biopsy

Abstract

The aim of this study was to determine pain during endometrial biopsy by comparing the use of intrauterine instillation of levobupivacaine or paracervical block with a placebo in a randomized, double-masked trial in premenopausal and postmenopausal women. A total of 90 women were enrolled in the study. Patients were allocated to either the control or case groups. Group 1 consisted of 30 cases with intrauterine anesthesia with 5 ml 0.5% levobupivacaine. Group 2 consisted of 30 patients who underwent paracervical block with lidocaine. No analgesic agent was given to the remaining 30 patients; these cases comprised the control group. The primary outcome measures were pain or discomfort experienced during the procedure. When the pain scores of the different groups were compared, the scores in the intrauterine levobupivacaine and paracervical block groups were found to be significantly lower compared to those in the control group. There was no difference between the levobupivacaine and paracervical block groups in terms of pain scores. There was a marked positive correlation between biopsy indications and pain scores. Pain scores were lower in cases with the indication of polymenorrhea, hypermenorrhea and metrorraghia compared to those in the cases with other indications. In conclusion, the transcervical intrauterine instillation of levobupivacaine or paracervical block with lidocaine brings about pain relief during and after endometrial biopsy.

The Effectiveness and Acceptability of Pipelle Endometrial Sampling versus Classical Dilatation and Curettage: A Three-Year Observational Study

“…Although several studies concluded that Pipelle significantly produced less pain than D&C [10,11,12], other studies reported the occurrence of mild-to-severe pain during Pippelle endometrial sampling [13,14,15]. …”

“…This might be related to the use of cervical tenaculum in some women during Pipelle endometrial sampling as its contribution for pain occurrence cannot be denied. However, other risk factors for associated pain in the Pipelle procedure might have a role such as negative pressure induced by the procedure or during intrauterine Pipelle insertion [11,12,13]. …”

“…The authors concluded that patients might suffer from mild to severe pain during Pipelle endometrial biopsy although it is one of the most common procedures performed without anesthesia in outpatient clinics. Traction of the cervix with the tenaculum, insertion of a Pipelle through the cervix and the negative pressure induced by the biopsy itself are all potential causes of pain [13]. …”

Vaginal Misoprostol versus a Rectal Nonsteroidal Anti-Inflammatory Drug to Reduce Pain during Pipelle Endometrial Biopsies: A Prospective, Randomized, Placebo-Controlled Trial

“…Traction of the cervix with the tenaculum, insertion of a Pipelle through the cervix and the biopsy itself are all potential causes of pain [11]. Medications blocking or reducing the nerve impulses during any part of the procedure may result in pain relief.…”

“…Although the Pipelle procedure is more comfortable than dilation and curettage, patients may still suffer from discomfort and pain. Several pain-reduction methods have been evaluated in the literature; for example, intrauterine anesthesia, intrauterine anesthesia plus a nonsteroidal anti-inflammatory drug (NSAID), topical analgesia, intrauterine anesthesia plus buccal misoprostol, and transcutaneous electrical nerve stimulation have been tested [5,6,7,8,9,10,11]. The local benzocaine study was the only study that did not demonstrate pain reduction [7].…”