Lignocaine aerosol spray in outpatient hysteroscopy: a randomized double-blind placebo-controlled trial

A randomized prospective comparative study of general versus epidural anesthesia for transcervical hysteroscopic endometrial resection

OBJECTIVE

This study was undertaken to compare general versus epidural anesthesia during hysteroscopic endometrial resection for dysfunctional uterine bleeding.

STUDY DESIGN

In a prospective comparative study, 24 women with abnormal uterine bleeding that was unresponsive to conservative medical management were randomly assigned to undergo hysteroscopic endometrial resection with either general or epidural anesthesia.

RESULTS

The durations of the endometrial resection procedure were similar for women who had general and epidural anesthesia (28.3 +/- 4.2 minutes vs 27.5 +/- 5.4 minutes, respectively). However, there was a statistically significantly lower absorption of distention fluid in women who underwent the procedure with general rather than epidural anesthesia (380.8 +/- 158.2 mL vs 648.3 +/- 157.1 mL, respectively; P < .0005).

CONCLUSION

A significantly lower amount of glycine distention fluid was absorbed during endometrial resection in women who underwent the procedure with general rather than epidural anesthesia.

Stepwise pain score analysis of the effect of local lignocaine on outpatient hysteroscopy: a randomized, double-blind, placebo-controlled trial

OBJECTIVE

To assess the efficacy of lignocaine gel in reducing the overall pain and pain of individual steps during outpatient hysteroscopy in comparison with placebo (no anesthesia).

DESIGN

A prospective, randomized, double-blind, placebo-controlled trial.

SETTING

Outpatient hysteroscopy clinic in a regional hospital in Hong Kong.

PATIENT(S)

A total of 500 Chinese patients undergoing outpatient hysteroscopy.

INTERVENTION(S)

Application of lignocaine gel to the cervix during outpatient hysteroscopy.

MAIN OUTCOME MEASURE(S)

Mean pain score using present pain intensity, overall pain score measured by total area under the curve, and the pain score of individual steps in the procedure in patients receiving lignocaine gel were compared with those of patients having no anesthesia. The failure rate and poor-view rate in both groups were also compared.

RESULT(S)

There were no statistically significant differences in mean pain score, overall pain score, and pain score of individual steps between the lignocaine group and controls. The failure rate and poor-view rate also showed no statistically significant differences.

CONCLUSION(S)

Outpatient hysteroscopy without anesthesia is acceptable to most Chinese women, and the local application of lignocaine gel is not effective in reducing pain.

The effect of local anaesthetic spray on the pain associated with local anaesthetic injection, prior to biopsy or loop diathermy to the cervix in the outpatient colposcopy clinic

We evaluated the effectiveness of local anaesthetic spray prior to injection of local anaesthetic before biopsy or large loop excision of the transformation zone of the cervix at colposcopy. This was a prospective, randomised, double-blind placebo-controlled study involving 51 women. Pain or discomfort was measured using a four-point categorical scale and a visual analogue score. Our results show that the use of local anaesthetic spray has no effect on the pain or discomfort experienced by patients having local anaesthetic injections to the cervix, and cannot be recommended.

Atraumatic cervical passage at outpatient hysteroscopy

OBJECTIVE

To evaluate the efficacy of topical anesthesia routinely administered to reduce discomfort and the need for additional local anesthesia during outpatient hysteroscopy.

DESIGN

Comparative observational study.

SETTING

Outpatient hysteroscopy clinic in a University hospital.

PATIENT(S)

Three hundred patients undergoing outpatient hysteroscopy.

INTERVENTION(S)

Application of lidocaine spray both to the surface of the cervix and into the cervical canal before performing hysteroscopy.

MAIN OUTCOME MEASURE(S)

The discomfort during passage of the hysteroscope through the cervical canal, the need for additional local anesthesia, and the failure rate of outpatient hysteroscopy.

RESULT(S)

One hundred fifty consecutive patients receiving lidocaine spray before the hysteroscopy were compared to a control group of another 150 consecutive patients who underwent the examination without pretreatment. Women treated with spray experienced significantly less pain at insertion of the hysteroscope. Furthermore, the spray significantly reduced both the need for additional anesthesia and the rate of failed hysteroscopies due to intolerable pain.

CONCLUSION(S)

Topical anesthesia with lidocaine spray is a simple method to alleviate patients' discomfort during cervical passage. It is effective in reducing the need for local anesthesia and should reduce the rate of failed outpatient hysteroscopies.