Comparison of pain and proper sample status according to usage of tenaculum and analgesia: a randomized clinical trial

Abstract

Objective Colposcopic biopsy is a discomfortable procedure. Additionally, it creates negative influence on sexuality. This study aimed to investigate the relationships among tenaculum, pain perception, and biopsy size during colposcopy. Methods In total, 228 patients who underwent colposcopy-directed biopsy were included, and randomized into 4 groups based on whether analgesic and tenaculum were used and replaced (tenaculum with n=58/without analgesic n=56, no tenaculum replacement with n=57/without analgesic n=57). Lidocaine hydrochloride (40 mg) plus adrenaline (0.025 mg) was administered in the analgesic groups. The pain was assessed using a linear visual analog scale. The biopsy specimen size was measured in millimeters. Results The mean age of the patients was 42.85±8.88 years. The most frequent colposcopy indications were atypical squamous cells of undetermined significance and human papilloma virus-positive results on cervical cytology (30.2%; n=69). Low-and high-grade intraepithelial lesions were noted in 14.91% (n=34) and 10.96% (n=25) women through colposcopy-directed biopsy results, respectively. Tenaculum replacement increased pain perception in the without analgesic group; however, no statistically significant differences were noted between of the groups with and without tenaculum replacement with analgesic. The size and number of biopsy specimens were not associated with tenaculum replacement and analgesic use. Conclusion Administration of analgesics decreased discomfort and pain in patients. Tenaculum replacement aided colposcopists in manipulating the cervix. Additionally, administration of analgesics relieved pain in the tenaculum replacement group.

Innovative Diagnostic and Therapeutic Interventions in Cervical Dysplasia: A Systematic Review of Controlled Trials

“…Using the remaining 37 citations, cross reference searching identified two further appropriate citations. Thus, in summary, 39 citations reporting on diagnostic and therapeutic interventions in women with cervical dysplasia within a controlled trial setting were included in this review [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Among them, we found 5 PCTs [ 13 , 14 , 15 , 16 , 17 ] and 28 RCTs [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , …”

“…We identified 12 studies. In total, 8 studies with 1390 participants were RCTs [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] and 4 studies with 893 participants were PCTs [ 13 , 14 , 15 , 16 ]. In 7 RCTs, interventions aimed at reducing pain during colposcopy and colposcopically-controlled cervical biopsies were evaluated [ 18 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

“…In total, 8 studies with 1390 participants were RCTs [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] and 4 studies with 893 participants were PCTs [ 13 , 14 , 15 , 16 ]. In 7 RCTs, interventions aimed at reducing pain during colposcopy and colposcopically-controlled cervical biopsies were evaluated [ 18 , 20 , 21 , 22 , 23 , 24 , 25 ]. In summary, these studies demonstrate that intravenous or intracervical lidocaine is efficacious for reducing pain [ 21 , 24 , 25 ] (this was not seen in one PCT [ 13 ]), whereas mixed results were reported for topical lidocaine spray on the cervix vs. placebo or forced coughing [ 18 , 23 ].…”

“…In 7 RCTs, interventions aimed at reducing pain during colposcopy and colposcopically-controlled cervical biopsies were evaluated [ 18 , 20 , 21 , 22 , 23 , 24 , 25 ]. In summary, these studies demonstrate that intravenous or intracervical lidocaine is efficacious for reducing pain [ 21 , 24 , 25 ] (this was not seen in one PCT [ 13 ]), whereas mixed results were reported for topical lidocaine spray on the cervix vs. placebo or forced coughing [ 18 , 23 ]. In addition, music as well as video colposcopy (with the patient watching the procedure) did not reduce pain during colposcopy [ 20 , 22 ].…”

“…Figure 2 shows the methodological quality of all 21 RCTs. In 6/21 trials, there was a significant risk of bias [ 24 , 25 , 28 , 36 , 43 , 45 ], limiting the validity of the results. Figure 3 shows the overall and specific bias risks given as a percentage of all RCTs.…”