Comparing the efficacy of intrauterine lidocaine and paracervical block in decreasing the pain associated with endometrial biopsy: a randomised trial

Investigating trends in those who experience menstrual bleeding changes after SARS-CoV-2 vaccination

Early in 2021, many people began sharing that they experienced unexpected menstrual bleeding after SARS-CoV-2 inoculation. We investigated this emerging phenomenon of changed menstrual bleeding patterns among a convenience sample of currently and formerly menstruating people using a web-based survey. In this sample, 42% of people with regular menstrual cycles bled more heavily than usual, while 44% reported no change after being vaccinated. Among respondents who typically do not menstruate, 71% of people on long-acting reversible contraceptives, 39% of people on gender-affirming hormones, and 66% of postmenopausal people reported breakthrough bleeding. We found that increased/breakthrough bleeding was significantly associated with age, systemic vaccine side effects (fever and/or fatigue), history of pregnancy or birth, and ethnicity. Generally, changes to menstrual bleeding are not uncommon or dangerous, yet attention to these experiences is necessary to build trust in medicine.

Methods of pain control during endometrial biopsy: A systematic review and meta-analysis of randomized controlled trials

AIM

To review effectiveness of methods for reducing pain during endometrial biopsy.

METHODS

PubMed, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases were searched for randomized controlled trials that examined effectiveness of pain control methods for endometrial biopsy. Risk of bias was assessed from sequence generation, allocation concealment, blinding, incomplete outcome data and selective outcome reporting. Heterogeneity was examined from forest plot, statistical tests of homogeneity, and I² statistic. For meta-analysis of pain scores, weighted mean difference with 95% confidence interval (CI) were estimated.

RESULTS

Twenty-six studies were included in the review. Marginally significant reduction in the pain score during the procedure in participants with intrauterine lidocaine relative to control was observed (mean difference [MD] -1.31, 95% confidence interval [CI] -2.70 to 0.09, P = 0.07). Subgroup analysis showed that in studies that used low-pressure suction devices, intrauterine lidocaine was associated with statistically significant reduction in pain during the procedure (MD -2.22, 95% CI -3.72 to -0.73, P = 0.004). There was a significantly lower pain score during biopsy in the anesthetic spray group compared to control (MD -0.96, 95% CI -1.53 to -0.39, P = 0.001). Significant heterogeneity on types of intervention and outcome measures among studies that examined paracervical block and nonsteroidal anti-inflammatory drugs (NSAID) was observed. However, paracervical block and NSAID were associated with significant pain reduction compared to placebo in most of the related studies.

CONCLUSION

Intrauterine anesthetics, anesthetic cervical spray, paracervical block and oral NSAID provide effective pain control during endometrial biopsy.

Hysteroscopic polypectomy: a comparison between 22 Fr and 26 Fr resectoscopes under paracervical block anesthesia, a randomized controlled study

Objective: The aim of this study was to compare 22 Fr unipolar resectoscope with the traditional 26 Fr unipolar resectoscope in endometrial polypectomy performed under paracervical block anesthesia. Methods: The trial took place in Gynecologic Unit, Department of Surgery, Tor Vergata University Hospital, Rome. Inclusion criteria were: diagnosis of endometrial polyps <3 cm at office hysteroscopy; agreement of patients to perform surgery under paracervical block anesthesia but not in office setting. Patients with ASA physical status classes III or more and with contraindication to operative hysteroscopy were excluded. Before the procedure, the recruited patients were randomly assigned to two groups, 35 to the 22 Fr unipolar resectoscope group (group A) and 35 to the 26 Fr unipolar resectoscope group (group B). Primary endpoint was the time spent for cervical dilatation and resection. Secondary endpoints were pain during and after surgery, efficacy of paracervical block, use of analgesic drugs during and after the procedure, patients' satisfaction, correlation between pain and menopause or parity. Statistical analysis was performed by the SPSS software, and the tests used were Pearson Chi-Square, One-way ANOVA and Mann-Whitney test. A p value <.05 was considered significant. Results: The mean time for cervical dilatation was two minutes in group A (26 Fr) and five minutes in group B (22 Fr, p = .001). Operative mean time was four minutes in group A and seven minutes in group B (p = .001). Pain during dilatation was analogous (VAS = 6, p = .054), while during the procedure it was higher in group B (VAS = 1 vs VAS = 2, p = .003). Sufentanil was administered during resection in 19 patients of group A and in 22 patients of group B (p = .754). General anesthesia was never necessary. Postoperative pain was higher in group B (p = .01). Nine patients of group B needed analgesics, as opposed to no patient of group A (p = .002). Conclusions: The 22 Fr unipolar resectoscope appears advantageous compared to the 26 Fr resectoscope in the resection of endometrial polyps <3 cm, in terms of cervical dilatation and operative time, pain and need of postoperative analgesics. Paracervical block is useful and safe in compliant patients at high risk for general anesthesia.