Pain relief for women with cervical intraepithelial neoplasia undergoing colposcopy treatment

Gajjar, Ketankumar; Martin-Hirsch, P; Bryant, Andrew; Owens, Gemma

doi:10.1002/14651858.cd006120.pub4

Cited by 16 publications

(21 citation statements)

References 33 publications

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“…LLETZ can be performed in the outpatient setting under various pain relief methods, with local anaesthesia (LA) being the most effective . In general, LA allows quicker operating times, fewer resources and faster recovery times.…”

Section: Introductionmentioning

confidence: 99%

LLETZ make it simple: Anxiety, pain and treatment outcomes with outpatient large loop excision of the transformation zone under local anaesthesia

Yap

Nathan

Farrell

2020

Aust NZ J Obst Gynaeco

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Background: Large loop excision of the transformation zone (LLETZ) is the preferred treatment for cervical intraepithelial neoplasia due to its effectiveness and ability to be performed in an outpatient setting under local anaesthesia (LA).Although current guidelines recommend that most LLETZ can be performed under LA, there is paucity in clinical data of patients' perspectives of outpatient LLETZ.Aim: Determining patient acceptability of outpatient LLETZ through assessment of anxiety and pain scores, and comparing treatment outcomes with current standards in terms of margins status, negative histology, short-term morbidity rates and follow-up attendance. Materials and Methods:This study was conducted at a tertiary hospital over two years (2014)(2015)(2016). Patients undergoing outpatient LLETZ completed a three-part questionnaire (before, immediately after and 4-6 weeks post-procedure). Results:One hundred and five patients underwent outpatient LLETZ. Mean pain score was 2 (range 0-8). Pre-procedure anxiety was common but most resolved post-procedure. Women who did not have a prior LLETZ discussion were more likely to report moderate-severe anxiety levels pre-procedure, compared with women who did (odds ratio 3.00, 95% CI 1.11-8.09, P = 0.030). There were no differences found in pain scores when comparing pre-procedure anxiety levels, prior discussion of LLETZ or mode of anaesthesia. Specimen margins were involved in 42.9%. No association was found between positive cervical margin status and age, pre-procedure anxiety or post-procedure pain scores. Most patients were satisfied and attended follow-up appointments. Conclusion:Large loop excision of the transformation zone under LA is a well-tolerated procedure with high satisfaction and follow-up rates. Clinicians need to initiate early discussions regarding treatment to minimise procedure-related anxiety. K E Y W O R D S anaesthesia, anxiety, cervical intraepithelial neoplasia, large loop excision of the transformation zone, pain

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Section: Introductionmentioning

confidence: 99%

LLETZ make it simple: Anxiety, pain and treatment outcomes with outpatient large loop excision of the transformation zone under local anaesthesia

Yap

Nathan

Farrell

2020

Aust NZ J Obst Gynaeco

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“…Colposcopy and related procedures have been recognized to be potentially painful [13]. Women experiencing pain during colposcopy are anxious, and interventions aimed at reducing the level of pain and anxiety before and during colposcopy are useful [14].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…While it is recognised that colposcopy and related procedures are potentially painful [19,11], there was a significant gap in the evidence-base on sensory experiences specifically related to biopsies. Our analysis has filled that gap.…”

Section: Discussionmentioning

confidence: 99%

Exploring women’s sensory experiences of undergoing colposcopy and related procedures: implications for preparatory sensory information provision

O’Connor

Waller

Martin

et al. 2016

Journal of Psychosomatic Obstetrics & Gynecology

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Our study provides unique in-depth insight into women's sensory experiences of colposcopy and related procedures and suggests women require more preparatory sensory information. The issues identified as contributing to women having a negative sensory experience may help inform the development of pre-colposcopy information which may better prepare women with abnormal cervical cytology for follow-up examinations.

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Pain relief for women with cervical intraepithelial neoplasia undergoing colposcopy treatment

Cited by 16 publications

References 33 publications

LLETZ make it simple: Anxiety, pain and treatment outcomes with outpatient large loop excision of the transformation zone under local anaesthesia

LLETZ make it simple: Anxiety, pain and treatment outcomes with outpatient large loop excision of the transformation zone under local anaesthesia

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

Exploring women’s sensory experiences of undergoing colposcopy and related procedures: implications for preparatory sensory information provision

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