Role of Local Anesthetics on Pain Relief in Endometrial Biopsy: Randomized Clinical Trial

Abstract

Objectives: Endometrial biopsy is necessary for diagnosing the reason of abnormal uterine bleeding in perimenopausal women. Currently outpatient endometrial biopsy is used for evaluation of abnormal uterine bleeding which is associated with moderate to severe pain. Using lidocaine is one of the procedures which is used for pain relief while biopsy. This study is aimed at comparing the effect of different local anesthesia procedures on pain relief during endometrial biopsy. Materials and Methods: In this randomized clinical trial, 160 multiparous 40-55 years old women with AUB (Abnormal Uterine Bleeding), candidates for endometrial biopsy, were randomly assigned into four equal groups, to receive: 1-intrauterine lidocaine; 2-cervical spray lidocaine; 3-intrauterine lidocaine plus cervical spray lidocaine; or 4-intrauterine distilled water. Pain relief was measured at 3 different times: during endometrial biopsy, just after and 15 minutes after biopsy. Results: Pain intensity was reduced significantly at different times in intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine receivers in compare with the groups which received cervical spray lidocaine and distilled water. The mean of difference pain relief during biopsy and 15 minutes after that was reduced significantly in the group which received intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine in comparison with the other two groups. Conclusion: Intrauterine lidocaine was effective during endometrial biopsy, and using it with cervical spray lidocaine had no more beneficial effect.

Pain Management for Gynecologic Procedures in the Office

“…31,32 Several trials demonstrated a modest benefit on pain with an intrauterine lidocaine infusion when compared with saline. 33,34 This is most commonly administered transcervically with a 91 Pain Management for Gynecologic Procedures • CME Review Article syringe attached to an angiocatheter, which is left in place between 3 and 5 minutes prior to endometrial biopsy to prevent backflow out of the cervical os. According to a recent systematic review by Mercier and Zerden, 35 intrauterine anesthesia for endometrial biopsy appears to be an effective technique for pain reduction with minimal adverse effects.…”

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

“…Similarly, in Olad‐Saheb‐Madarek et al . study, application of 3 puffs of lidocaine spray did not provide significant pain reduction during endometrial biopsy using a 3‐mm pipelle compared to placebo. In that study, intrauterine instillation of lidocaine appeared effective in pain control.…”

“…Because cervical dilation is rarely needed during endometrial biopsy and the influence of tenaculum use on pain is of questionable significance, the pain and discomfort originated from the cervix would have minor impact on total pain perception. This can explain the demonstrable effectiveness of intrauterine lidocaine that has direct effect on the uterine corpus and of preoperative administration of NSAID that act systematically for reduction of pain during endometrial biopsy in previously published reports . This reflection could also elucidate the ineffectiveness of local anesthetics in the form of spray or gel applied to the cervix in the current and other studies examining endometrial biopsy .…”

“…This can explain the demonstrable effectiveness of intrauterine lidocaine that has direct effect on the uterine corpus and of preoperative administration of NSAID that act systematically for reduction of pain during endometrial biopsy in previously published reports. 2,3,5,6,8,12,[16][17][18] This reflection could also elucidate the ineffectiveness of local anesthetics in the form of spray or gel applied to the cervix in the current and other studies examining endometrial biopsy. 8,13,23 Therefore, the beneficial effect of lidocaine spray applied to the cervix during the procedures involving significant manipulation of the cervix by either excision (LEEP) or dilation (surgical abortion and hysteroscopy) is reasonable.…”

“…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.…”