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El-Ghazaly TE, Abdelazim IA, Elshabrawy A. Intrauterine Levobupivacaine Instillation for Pain Control in Women Undergoing Diagnostic Hysteroscopy. Gynecol Minim Invasive Ther 2022; 11:209-214. [PMID: 36660333 PMCID: PMC9844048 DOI: 10.4103/gmit.gmit_48_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023] Open
Abstract
Objectives Many women experience pain and discomfort after hysteroscopic procedure. Pain and discomfort after hysteroscopic procedures can be explained by the cervical dilatation, intrauterine manipulation, and/or hydrodistension. This study designed to evaluate the efficacy of intrauterine levobupivacaine instillation for pain control in women undergoing diagnostic hysteroscopy. Materials and Methods One hundred and twenty (120) women scheduled for diagnostic hysteroscopy and endometrial biopsy due to uterine bleeding were included in this study and randomized either to levobupivacaine group or controls. At the end of hysteroscopy, 5 mL of 0.5% levobupivacaine was instilled intrauterine in levobupivacaine group, while 5 mL of 0.9% saline was instilled intrauterine in controls. Participants were kept in the hospital for 12 h after diagnostic hysteroscopy to detect the postoperative (PO) pain intensity using visual analog scale (VAS), and PO required analgesics. Results The VAS was significantly lower in levobupivacaine group compared to controls 3 h. PO (1.31 ± 1.02 vs. 1.62 ± 0.76, respectively), (P = 0.01), 6 h. PO (0.81 ± 1.24 vs. 1.53 ± 0.88, respectively), (P = 0.004), and 9 h. PO (0.55 ± 1.25 vs. 1.12 ± 0.95, respectively), (P = 0.01). The total PO required analgesics were significantly lower in levobupivacaine group compared to controls (P = 0.005). Conclusion The intrauterine levobupivacaine instillation was simple, and effective for pain relief after diagnostic hysteroscopy, it significantly decreased pain score assessed by VAS at 3, 6, and 9 h., PO, and it significantly decreased PO required analgesics.
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Affiliation(s)
| | - Ibrahim A. Abdelazim
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt,Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait,Address for correspondence: Dr. Ibrahim A. Abdelazim, Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Kuwait, P.O. Box: 9758, 61008 Ahmadi, Kuwait. E-mail:
| | - A. Elshabrawy
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
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Jayeola DK, Bello TO, Oyedepo VO, Famurewa OC. The efficacy of oral naproxen and cervical lidocaine spray on perceived pain during hysterosalpingography. Niger Postgrad Med J 2021; 28:193-197. [PMID: 34708706 DOI: 10.4103/npmj.npmj_577_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective This study was carried out to evaluate the efficacy of the combined use of oral naproxen and cervical lidocaine spray during hysterosalpingography (HSG) compared to the use of oral naproxen or cervical lidocaine spray alone. Materials and Methods: This prospective randomised controlled study was carried out using a total of 240 patients who were randomly assigned to four groups. Group 1 received cervical lidocaine spray only, Group 2 received oral naproxen only, Group 3 received cervical lidocaine spray and naproxen tablet, whereas Group 4 was the control group. A visual analogue scale was used for subjective pain assessment at three pre-defined steps. Results The mean pain scores of the patients in each of the four groups are Group 1 (3.6 ± 2.0, 5.1 ± 1.8, 5.8 ± 2.2); Group 2 (2.7 ± 1.4, 3.6 ± 2.0 and 3.9 ± 1.9); Group 3 (2.8 ± 1.5, 3.4 ± 2.0 and 4.2 ± 2.3); Group 4 (4.7 ± 1.7, 5.9 ± 1.7 and 5.3 ± 1.7) at T1, T2 and T3, respectively. Pain perception was statistically significantly reduced by naproxen and combined naproxen plus lidocaine spray at all the stages of HSG while cervical lidocaine spray had a statistically significant reduction in pain perception only during cervical instrumentation. Conclusion Oral naproxen and combined naproxen plus cervical lidocaine spray were effective in reducing HSG-associated pain during all the stages of HSG. However, combined oral naproxen and lidocaine spray did not show superior efficacy over oral naproxen alone. Cervical lidocaine spray was not an effective method.
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Affiliation(s)
- David Kehinde Jayeola
- Department of Radiology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria
| | - Temitope Olugbenga Bello
- Department of Radiology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria
| | - Victor Olufemi Oyedepo
- Department of Radiology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria
| | - Olusola Comfort Famurewa
- Department of Radiology, Obafemi Awolowo Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
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Effect of video information on anxiety level in women undergoing endometrial biopsy. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.771462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Charoenkwan K, Nantasupha C. Methods of pain control during endometrial biopsy: A systematic review and meta-analysis of randomized controlled trials. J Obstet Gynaecol Res 2019; 46:9-30. [PMID: 31667985 DOI: 10.1111/jog.14152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/07/2019] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chalaithorn Nantasupha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Miles SM, Shvartsman K, Dunlow S. Intrauterine lidocaine and naproxen for analgesia during intrauterine device insertion: randomized controlled trial. Contracept Reprod Med 2019; 4:13. [PMID: 31516731 PMCID: PMC6734494 DOI: 10.1186/s40834-019-0094-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluates oral naproxen and intrauterine instillation of lidocaine for analgesia with intrauterine device (IUD) placement as compared to placebo. Methods This was a randomized, double-blind, placebo-controlled trial. Patients desiring levonorgestrel 52 mg IUD or Copper T380A IUD were randomized into treatment groups. Patients received either oral naproxen 375 mg or placebo approximately 1 h prior to procedure in conjunction with 5 mL of 2% lidocaine or 5 mL of intrauterine saline. The primary outcome was pain with IUD insertion measured on a visual analog scale immediately following the procedure. Prespecified secondary outcomes included physician pain assessment, post procedure analgesia, satisfaction with procedure, satisfaction with IUD, and pain assessment related to IUD type. Results From June 4, 2014 to October 28, 2016 a total of 160 women desiring Copper T380A or levonorgestrel 52 mg intrauterine device insertion and meeting study criteria were enrolled and randomized in the study. Of these, 157 (78 in the Copper T380A arm, 79 in the levonorgestrel 52 mg) received study treatment medication. There were 39 in naproxen/lidocaine arm, 39 in placebo/lidocaine arm, 40 in naproxen/placebo arm, and 39 in placebo/placebo arm. There were no differences in the mean pain scores for IUD placement between treatment groups (naproxen/lidocaine 3.38 ± 2.49; lidocaine only 2.87 ± 2.13; naproxen only 3.09 ± 2.18; placebo 3.62 ± 2.45). There was no difference in self-medication post procedure or in satisfaction with the procedure and IUD among women in the treatment arms or by type of IUD. Conclusion Naproxen with or without intrauterine lidocaine does not reduce pain with IUD placement. Clinical trial registration Clinicaltrials.gov, NCT02769247. Registered May 11, 2016, Retrospectively registered.
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Affiliation(s)
- Shana M Miles
- Second Medical Group, 243 Curtiss Rd, Barksdale AFB, Louisiana, 71110 USA
| | - Katerina Shvartsman
- 2Department of Obstetrics and Gynecology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD 20814 USA
| | - Susan Dunlow
- 3Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889 USA
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Abbas AM, Samy A, El-Naser Abd El-Gaber Ali A, Khodry MM, Ahmed MA, El-Rasheedy MI, Abdallah KM, Mohammed AE, Abdelbaky WH, Raslan OK, Badawy MA, Elktatny HH. Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis. Fertil Steril 2019; 112:140-148.e12. [DOI: 10.1016/j.fertnstert.2019.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/28/2022]
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Piyawetchakarn R, Charoenkwan K. Effects of lidocaine spray for reducing pain during endometrial aspiration biopsy: A randomized controlled trial. J Obstet Gynaecol Res 2019; 45:987-993. [DOI: 10.1111/jog.13932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ratpaporn Piyawetchakarn
- Department of Obstetrics and Gynecology, Faculty of MedicineChiang Mai University Chiang Mai Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of MedicineChiang Mai University Chiang Mai Thailand
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Efficacy of Intrauterine Lidocaine Instillation in Reducing Pain during Endometrial Biopsy by Novak. PAIN RESEARCH AND TREATMENT 2018; 2018:9368298. [PMID: 30515325 PMCID: PMC6236577 DOI: 10.1155/2018/9368298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/27/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022]
Abstract
Abnormal uterine bleeding in women aged 35 years or over is an important clinical sign of many gynecological conditions. The diagnoses of these conditions require the pathological report of the endometrial tissue. Outpatient-based endometrial biopsy is an excellent option compared to standard fractional uterine curettage or hysteroscopy with endometrial biopsy in providing a definite diagnosis for abnormal uterine bleeding as it is less painful and does not require high potency anesthesia. This study evaluates the effect of intrauterine lidocaine on the patient's pain score during endometrial biopsy by the Novak curette. We included patients aged 35 years or more who had abnormal uterine bleeding between December 2016 and March 2018. The study was conducted at Thammasat University Hospital, Pathum Thani, Thailand. 250 patients were randomly allocated to either receive intrauterine lidocaine (study group) or normal saline (control group). Assessment of pain severity was evaluated using a visual analogue scale (VAS) score at 6 time-points, namely, before performing the procedure, when grasping the cervix by the tenaculum, during the intrauterine instillation of lidocaine or normal saline, during the uterine curettage, and then 15 minutes and 2 hours after the procedure. This study showed that there was significant pain reduction in patients who received intrauterine instillation of lidocaine compared to placebo, during uterine curettage, as well as 15 minutes and 2 hours after procedure (p<0.0001). Patient satisfaction was not significantly different between the two groups, while physician satisfaction significantly improved in the lidocaine group. Serious complications were not found during this study. (This research project had been approved for registration at Thai Clinical Trials Registry. TCTR identification number is TCTR20161031003.).
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The Efficacy of Lidocaine Spray in Pain Relief during Outpatient-Based Endometrial Sampling: A Randomized Placebo-Controlled Trial. PAIN RESEARCH AND TREATMENT 2018; 2018:1238627. [PMID: 30420917 PMCID: PMC6215546 DOI: 10.1155/2018/1238627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/02/2018] [Indexed: 11/17/2022]
Abstract
Abnormal vaginal bleeding is one of the most frequent problems found in gynecology. Endometrial histopathology is needed for definite diagnosis. It was obtained either from endometrial tissue sampling or from standard uterine curettage. Office endometrial tissue sampling is an easy and low morbid procedure. It is usually associated with pain and discomfort. Topical anesthetic agent is needed for pain relieving. This study was conducted in outpatient gynecology clinic, Thammasat University Hospital, Thailand. It was a double blind randomized controlled trial. A total of 140 participants were enrolled in study and control group. Each group consisted of 70 cases. Study group received topical spray of 10% lidocaine (40 mg) before endometrial aspiration. Topical spray of 0.9% normal saline was performed in control group. Novak curettage was an application for endometrial tissue obtaining in this study. Visual analog scale (10cm-VAS) was used for pain evaluation. Demographic character of both groups showed no statistical difference. The percentage of participants who had severe pain (VAS≥7) during tenaculum application and Novak curettage insertion and during procedure were 28.5% (20/70) versus 12.9% (9/70), 55.7% (39/70) versus 38.5% (27/70), and 78.5% (55/70) versus 60% (42/70) in control and study group, respectively. Both groups had no significant differences of postoperative pain at 15 minutes and 2 hours. This study indicates that topical lidocaine spray can relieve pain during endometrial tissue sampling.
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Sampaio BF, DeRossi R, Menezes PH, Escobar LL, Milan B. Effects of a Caudal Epidural Anesthesia Using Midazolam With or Without Lidocaine to Perform an Endometrial Biopsy in Mares. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Özkan S, Kars B, Sakin Ö, Onan Yılmaz A, Bektaş YT, Kaşıkçı HÖ. The optimal analgesic method in saline infusion sonogram: A comparison of two effective techniques with placebo. Turk J Obstet Gynecol 2017; 13:132-136. [PMID: 28913108 PMCID: PMC5558303 DOI: 10.4274/tjod.46667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 09/06/2016] [Indexed: 12/01/2022] Open
Abstract
Objective: Operations performed with local anesthesia can sometimes be extremely painful and uncomfortable for patients. Our aim was to investigate the optimal analgesic method in saline infusion sonograms. Materials and Methods: This study was performed in our Clinic of Obstetrics and Gynecology between March and August 2011. Ninety-six patients were included. Patients were randomly divided into groups that received saline (controls, group 1), paracervical block (group 2), or paracervical block + intrauterine lidocaine (group 3). In all groups, a visual analogue scale score was performed during the tenaculum placement, while saline was administered, and 30 minutes after the procedure. Results: When all the patients were evaluated, the difference in the visual analogue scale scores in premenopausal patients during tenaculum placement, during the saline infusion into the cavity, and 30 minutes following the saline infusion sonography were statistically different between the saline and paracervical block groups, and between the saline and paracervical block + intrauterine lidocaine group. However, there was no statistically significant difference between paracervical block and paracervical block + intrauterine lidocaine groups. Conclusion: As a result of our study, paracervical block is a safe method to use in premenopausal patients to prevent pain during saline infusion sonography. The addition of intrauterine lidocaine to the paracervical block does not increase the analgesic effect; moreover, it increases the cost and time that the patient stays in the dorsolithotomy position by 3 minutes.
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Affiliation(s)
- Sadullah Özkan
- Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Bülent Kars
- Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Önder Sakin
- Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Aylin Onan Yılmaz
- Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Yaren Tuba Bektaş
- Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Halim Ömer Kaşıkçı
- Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Family Medicine, İstanbul, Turkey
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Karaca I, Yapca OE, Adiyeke M, Toz E, Karaca SY. Effect of Cervical Lidocaine Gel for Pain Relief in Pipelle Endometrial Sampling. Eurasian J Med 2017; 48:189-191. [PMID: 28149144 DOI: 10.5152/eurasianjmed.2016.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of cervical lidocaine gel in reducing patient discomfort during Pipelle endometrial sampling. MATERIALS AND METHODS From September 2012 to January 2013, 137 patients were evaluated with Pipelle endometrial biopsy. For group 1 (77 women), 2% lidocaine gel was applied to the cervical canal 3 min before endometrial sampling. For group 2 (60 women), a placebo gel was applied. The pain experienced by the patients during biopsy was evaluated using a 100 mm visual analog scale. RESULTS The pain score was significantly lower during suction curettage (T3) in the group 1 than in the group 2. There was no significant difference between the groups in terms of pain score in other stages of the procedure (2.6±1.3 and 4.5±1.4; p=0.03). CONCLUSION Cervical 2% lidocaine gel is simple and effective for decreasing pain associated with Pipelle endometrial biopsy.
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Affiliation(s)
- Ibrahim Karaca
- Clinic of Obstetrics and Gynecology, Aliağa State Hospital, İzmir, Turkey
| | - Omer Erkan Yapca
- Department of Obstetrics and Gynecology, Ataturk University, School of Medicine, Erzurum, Turkey
| | - Mehmet Adiyeke
- Clinic of Obstetrics and Gynecology, Buca Maternity Hospital, İzmir, Turkey
| | - Emrah Toz
- Clinic of Obstetrics and Gynecology, Tepecik Research and Training Hospital, İzmir, Turkey
| | - Suna Yildirim Karaca
- Clinic of Obstetrics and Gynecology, Tepecik Research and Training Hospital, İzmir, Turkey
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Arora A, Shukla A, Saha SC. Effectiveness of Intrauterine Lignocaine in Addition to Paracervical Block for Pain Relief during Dilatation and Curettage, and Fractional Curettage. J Obstet Gynaecol India 2016; 66:174-9. [PMID: 27298527 PMCID: PMC4870661 DOI: 10.1007/s13224-014-0670-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 12/28/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE OF STUDY Dilatation and curettage (D&C) and fractional curettage (F/C) are commonly performed gynecological procedures. Randomized controlled trials have concluded that topical anesthesia effectively reduces pain in endometrial sampling and hysteroscopy. Our study was aimed at investigating this modality of pain relief in setting of a developing country where, due to lack of resources, successful completion of these procedures in an outpatient setting is a necessity. METHODS This study was a prospective, randomized, placebo-controlled, double-blind study conducted in 84 patients. All patients received either intrauterine 2 % lignocaine or normal saline along with oral NSAID and paracervical block prior to the procedure. The pain was analyzed at three steps: at the time of curette, immediately post-procedure, and 30 min later using 10-cm visual analog score. RESULTS The patients in the experimental and control groups were well matched for age, parity, body mass index, menopausal status, and the indications for intervention. At all the three stages, pain perceived in the lignocaine group was significantly less as compared to that in placebo group. As compared to lignocaine group (55 %), significantly higher number of women in placebo group (88 %) perceived severe pain during endometrial curettage (p = 0.001). CONCLUSIONS The present study indicates that two percent intrauterine lignocaine significantly decreases the pain perception during intrauterine gynecological procedures such as D&C and F/C. This is a simple, effective, inexpensive, and low-risk intervention which can potentially increase the patient acceptability and compliance with such procedures.
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Affiliation(s)
- Aashima Arora
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Ajitabh Shukla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Subhas Chander Saha
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
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Fouda UM, Salah Eldin NM, Elsetohy KA, Tolba HA, Shaban MM, Sobh SM. Diclofenac plus lidocaine gel for pain relief during intrauterine device insertion. A randomized, double-blinded, placebo-controlled study. Contraception 2016; 93:513-8. [DOI: 10.1016/j.contraception.2016.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 11/16/2022]
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Aksoy H, Aksoy U, Ozyurt S, Acmaz G, Babayigit MA, Yücel B, Aydin T. Effect of lidocaine spray in pain management during office-based endometrial sampling: A randomised placebo-controlled trial. J OBSTET GYNAECOL 2015; 36:246-50. [PMID: 26471087 DOI: 10.3109/01443615.2015.1060201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Office-based endometrial sampling is the most frequently performed gynaecological procedure. The procedure is usually associated with pain and discomfort. Several anaesthetic and analgesic techniques (e.g., non-steroidal anti-inflammatory drugs, paracervical block, misoprostol and topical anaesthetics) are used for pain management during endometrial sampling. There is no comprehensive study using lidocaine in spray form; we sought to investigate the analgesic efficacy of 10% lidocaine spray in patients undergoing office-based endometrial biopsy. We conducted a prospective, randomised (lidocaine spray (n = 60) and placebo (n = 60), respectively), double-blind study. The mean pain score during procedure was 3.51 ± 1.51 in the lidocaine spray group and 5.11 ± 1.66 in the placebo group. Lidocaine spray treatment significantly lowered the pain scores compared with placebo (p < 0.001). Lidocaine spray can be accepted as a non-invasive, easy to apply and more comfortable anaesthetic method for office-based endometrial sampling.
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Affiliation(s)
- H Aksoy
- a Kayseri Military Hospital , Department of Obstetrics and Gynaecology , Kayseri , Turkey
| | - U Aksoy
- b Kayseri Education and Training Hospital , Department of Obstetrics and Gynaecology , Kayseri , Turkey
| | - S Ozyurt
- b Kayseri Education and Training Hospital , Department of Obstetrics and Gynaecology , Kayseri , Turkey
| | - G Acmaz
- b Kayseri Education and Training Hospital , Department of Obstetrics and Gynaecology , Kayseri , Turkey
| | - M A Babayigit
- c Gulhane Military Medical Academy , Department of Public Health , Kayseri , Turkey
| | - B Yücel
- d Acibadem Hospital , Department of Obstetrics and Gynaecology , Kayseri , Turkey
| | - T Aydin
- d Acibadem Hospital , Department of Obstetrics and Gynaecology , Kayseri , Turkey
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Mercier RJ, Liberty A. Intrauterine lidocaine for pain control during laminaria insertion: a randomized controlled trial. Contraception 2014; 90:594-600. [PMID: 25139724 DOI: 10.1016/j.contraception.2014.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/13/2014] [Accepted: 07/16/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if intrauterine administration of 5 cc of 2% lidocaine in addition to paracervical block reduces pain during laminaria insertion, when compared with paracervical block and saline placebo. STUDY DESIGN This was a randomized, double blind placebo-controlled trial. Women presenting for abortion by dilation and evacuation (D&E) at 14-24 weeks gestational age were randomized to receive an intrauterine instillation of either 5 mL of 2% lidocaine or 5 mL of normal saline, in addition to standard paracervical block with 20 cc of 0.25% bupivacaine. Our primary outcome was self-reported pain scores on a 100mm Visual Analogue Scale (VAS) immediately following laminaria insertion. Secondary outcome was self-reported VAS pain score indicating the maximum level of pain experienced during the 24-48-h interval between laminaria insertion and D&E procedure. RESULTS Seventy-two women were enrolled, and data for 67 women were analyzed, only two of whom were more than 21 weeks on gestation. The range of pain scores at both time points was large (1-90 mm at laminaria insertion; 0-100mm in laminaria-D&E interval). Mean pain scores were not different between treatment groups at laminaria insertion, (33 vs. 32, p=.8) or in the laminaria - D&E interval (43 vs. 44, p=.9). CONCLUSION Intrauterine administration of 5 cc of 2% lidocaine in addition to paracervical block did not reduce pain with laminaria insertion when compared to paracervical block with saline placebo. IMPLICATIONS Intrauterine lidocaine combined with paracervical block does not improve pain control at laminaria insertion when compared with paracervical block and saline placebo. Wide variation in pain scores and persistent pain after laminaria insertion suggests patient would benefit from more effective methods of pain control at laminaria insertion and during the post-laminaria interval.
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Affiliation(s)
- Rebecca J Mercier
- Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Abigail Liberty
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Bednarek PH, Creinin MD, Reeves MF, Cwiak C, Espey E, Jensen JT. Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial. Contraception 2014; 91:193-7. [PMID: 25487172 DOI: 10.1016/j.contraception.2014.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate if ibuprofen 800mg reduces pain with intrauterine device (IUD) insertion among U.S. women. STUDY DESIGN We conducted a randomized, double-blind, placebo-controlled trial of women undergoing IUD insertion approximately 2-6weeks following first-trimester uterine aspiration. Subjects were randomized to receive ibuprofen 800mg or placebo 30-45min prior to IUD insertion. A 100-mm visual analog scale (VAS) was administered to measure pain after speculum insertion (baseline) and immediately following IUD insertion. RESULTS A total of 202 women were enrolled, with 101 randomized to each group (ibuprofen or placebo). Sociodemographic characteristics and baseline VAS scores were similar between groups. The median pain score with IUD insertion was 41.5mm in the placebo group and 38.0mm in the ibuprofen group (p=.50). Mean and median pain scores did not differ between placebo and ibuprofen when nulliparous and parous women were analyzed independently. Overall, median pain scores were 17.5mm higher in nulliparous women than parous women (p=.004). Median pain scores did not differ by age, IUD-type, history of dysmenorrhea or time since aspiration. CONCLUSIONS Administration of ibuprofen 800mg prior to IUD insertion does not reduce pain associated with the procedure for U.S. women. Overall, nulliparous women report more pain with IUD insertion than multiparous women.
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Affiliation(s)
- Paula H Bednarek
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | | | - Carrie Cwiak
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Jeffrey T Jensen
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
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Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial. Fertil Steril 2014; 102:1398-403. [DOI: 10.1016/j.fertnstert.2014.07.1249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/15/2014] [Accepted: 07/25/2014] [Indexed: 11/21/2022]
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Telli E, Aydin Y, Oge T, Yalcin OT. Vaginal misoprostol versus a rectal nonsteroidal anti-inflammatory drug to reduce pain during Pipelle endometrial biopsies: a prospective, randomized, placebo-controlled trial. Gynecol Obstet Invest 2014; 78:230-4. [PMID: 25034509 DOI: 10.1159/000363748] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/18/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND To evaluate and compare the efficacy of vaginal misoprostol and a rectal nonsteroidal anti-inflammatory drug (NSAID) on pain relief during Pipelle endometrial biopsies in a placebo-controlled randomized study. METHODS One hundred and fifty-one women who had an indication for a Pipelle endometrial biopsy were randomized into three groups as follows: group 1, vaginal misoprostol; group 2, rectal NSAID, and group 3, control. After the procedure, the women were asked to record their pain severity on a visual analog scale. The secondary outcome of the study was patient acceptability, and vasovagal symptoms and analgesic requirements after the procedure were also recorded. RESULTS There were no statistically significant differences in the demographic characteristics of the patients. The primary study outcome was the comparison of the median visual analog scale pain scores of groups 1 and 2 versus group 3 (controls); no statistically significant differences were found (p = 0.502). In addition, the patient acceptability (Likert scale), vasovagal symptoms and analgesic requirements after the procedure were similar among the groups (p = 0.204, 1 and 0.546, respectively). CONCLUSION Our study did not demonstrate a reduction in pain relief during Pipelle endometrial biopsies for patients receiving vaginal misoprostol or a rectal NSAID when compared to patients receiving placebo treatment.
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Affiliation(s)
- Elcin Telli
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
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Kass-Wolff JH, Fisher JE. Evidence-based pain management for endometrial biopsies and IUD insertions. Nurse Pract 2014; 39:43-50. [PMID: 24535311 DOI: 10.1097/01.npr.0000434094.19101.d1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intrauterine device (IUD) insertions and endometrial biopsies (EMB) are common outpatient office procedures performed by advanced practice nurses. There are currently no guidelines for pain management with either IUD insertions or EMB procedures. Combination modalities are the most likely to impact pain perception, but more research is required in this area.
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Affiliation(s)
- Jane H Kass-Wolff
- Jane H. Kass-Wolff is an Assistant Professor at University of Colorado Anschutz Medical Campus, Division of Women, Children, and Families, Aurora, Colo. Jennifer E. Fisher is an Assistant Director, Center for Advancing Professional Excellence and Associate Professor in the Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colo
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Transcervical intrauterine levobupivacaine or lidocaine infusion for pain control during endometrial biopsy. Pain Res Manag 2014; 19:82-6. [PMID: 24445389 DOI: 10.1155/2014/104053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Endometrial biopsy is a common procedure for the investigation of many gynecological disorders including abnormal uterine bleeding, postmenopausal bleeding, abnormal cytology and infertility. Most women experience some degree of discomfort and pain during the procedure. Pain may occur during dilation of the cervix for insertion of the catheter and during endometrial biopsy, which further aggravates pain by inducing uterine contraction. OBJECTIVES To determine pain levels during endometrial biopsy by comparing intrauterine instillation of levobupivacaine or lidocaine with placebo in a randomized, double-blinded trial in pre- and postmenopausal women. METHODS Ninety patients were allocated to either control or experimental groups before endometrial biopsy. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine or 2% lidocaine (experimental groups). Resident doctors used the same endometrial biopsy technique to minimize the risk of technical variation. All tissue specimens were sent for cytopathological examination. The pathologists, who were blinded to the study solution, analyzed all tissue specimens. The primary outcome measure was pain experienced during the procedure. Pain was assessed using a 10 cm visual analogue pain scale. All observed adverse effects were recorded until the patients were discharged. RESULTS Pain scores of the intrauterine lidocaine and levobupivacaine groups were found to be significantly lower than the control group. There was no difference between the levobupivacaine and lidocaine groups with regard to pain scores. There was a moderately positive correlation between pain scores and endometrial thickness. No complications were observed due to the procedure. Most of the biopsy results were proliferative and secretory endometrium. Insufficient material causing inconclusive results was observed mostly in the control group. CONCLUSION Transcervical intrauterine topical instillation of levobupivacaine or lidocaine causes pain relief during endometrial biopsy. However, further studies are needed to evaluate the effectiveness of intrauterine anesthesia, to determine optimal concentration, volume and waiting time according to the type of local anesthetic agent, and to assess the applicability of the method to other intrauterine procedures.
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Cengiz H, Dağdeviren H, Kaya C, Yeşil A, Çaypınar SS. Comparing the efficacy of intrauterine lidocaine and paracervical block in decreasing the pain associated with endometrial biopsy: a randomised trial. Arch Gynecol Obstet 2013; 289:609-14. [DOI: 10.1007/s00404-013-3036-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/19/2013] [Indexed: 11/27/2022]
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Olad-Saheb-Madarek E, Ghojazaeh M, Behjati F, Alikhah H. The effect of different local anesthesia methods on pain relief in outpatient endometrial biopsy: randomized clinical trial. J Caring Sci 2013; 2:211-8. [PMID: 25276729 DOI: 10.5681/jcs.2013.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 03/01/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION 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. METHODS In this randomized clinical trial, 160 multiparous 40-55 years old women with AUB, 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.
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Affiliation(s)
| | - Morteza Ghojazaeh
- Women's reproductive health research center, Tabriz University of Medicine Sciences, Tabriz, Iran
| | - Fahimeh Behjati
- Women's reproductive health research center, Tabriz University of Medicine Sciences, Tabriz, Iran
| | - Hossein Alikhah
- Expert , Publication office, Tabriz University of Medicine Sciences, Tabriz, Iran
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Kucukgoz Gulec U, Khatib G, Guzel AB, Akil A, Urunsak IF, Ozgunen FT. The necessity of using tenaculum for endometrial sampling procedure with pipelle: a randomized controlled study. Arch Gynecol Obstet 2013; 289:349-56. [DOI: 10.1007/s00404-013-3005-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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Nelson AL, Fong JK. Intrauterine infusion of lidocaine does not reduce pain scores during IUD insertion. Contraception 2013; 88:37-40. [PMID: 23375352 DOI: 10.1016/j.contraception.2012.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/05/2012] [Accepted: 12/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Potential pain with IUD insertion is a concern for women. Studies have found that systemic and local cervical therapies do not reduce pain scores. Since intrauterine infusion of lidocaine may reduce pain with endometrial aspiration, in this pilot study, we tested whether such infusion through an inexpensive endometrial aspirator could reduce IUD insertion pain scores with IUD insertion. STUDY DESIGN In this randomized, double-blinded, placebo control pilot study of 40 women undergoing IUD insertion, pain scores of women receiving 1.2 mL 2% lidocaine versus normal saline (1:1) infused 3 min prior to IUD insertion were measured using a 0-9-point scale. RESULTS Pain at tenaculum placement was similar between groups. There was no difference in mean pain scores during IUD insertion of women infused with lidocaine (2.95) versus normal saline (3.75), p=.37. Considerable variation in pain scores was noted; 46% of subjects had pain scores ≤2 while 33% had pain scores ≥5. CONCLUSION Use of 2% lidocaine administered through an endometrial aspirator did not significantly reduce IUD insertion pain scores in this pilot study.
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Affiliation(s)
- Anita L Nelson
- Department of Obstetrics and Gynecology, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical CenterTorrance, CA, USA.
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Abstract
OBJECTIVE To assess the effectiveness of intrauterine local anesthesia in reducing pain associated with outpatient gynecologic procedures. DATA SOURCES We searched online databases PubMed or MEDLINE, Embase, Google Scholar, and Clinicaltrials.gov and hand-searched reference lists from reviews evaluating pain-control methods for gynecologic office procedures. We identified randomized controlled trials using intrauterine local anesthetic in gynecologic procedures. METHODS Titles and abstracts were screened for 1,236 articles. We identified 45 potential articles for inclusion. We excluded 22 of these studies because: 1) they were not randomized controlled trials; 2) they did not describe a quantifiable dose of medication used in the study; 3) they did not investigate an intrauterine anesthetic; 4) they did not study a potentially awake, outpatient procedure; and 5) they did not clearly report results or represented duplicate publication. Twenty-three articles were ultimately included for review. TABULATION, INTEGRATION, AND RESULTS Two authors independently reviewed full search results and assessed eligibility for inclusion and independently abstracted data from all articles that met criteria for inclusion. Disagreements regarding eligibility or abstraction data were adjudicated by a third independent person. Our primary end point was the reported effect of intrauterine local anesthesia on patient-reported pain scores. As a result of heterogeneity in study methods, outcome measures, and reporting of outcomes, results could not be combined in a meta-analysis. Good evidence supports use of intrauterine anesthesia in endometrial biopsy and curettage, because five good-quality studies reported reduced pain scores, whereas only one good-quality study reported negative results. We found moderate evidence to support intrauterine anesthesia in hysteroscopy, because one good-quality study and two fair or poor quality studies reported reduced pain scores, whereas two good-quality studies had negative results. Good evidence suggests that intrauterine anesthesia is not effective in hysterosalpingography; three good-quality studies reported that pain scores were not reduced, and no good quality studies showed a beneficial effect in that procedure. Evidence was insufficient concerning first-trimester abortion, saline-infusion ultrasonogram, tubal sterilization, and intrauterine device insertion. CONCLUSION Intrauterine local anesthesia can reduce pain in several gynecologic procedures including endometrial biopsy, curettage, and hysteroscopy and may be effective in other procedures as well.
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Isley MM, Jensen JT, Nichols MD, Lehman A, Bednarek P, Edelman A. Intrauterine lidocaine infusion for pain management during outpatient transcervical tubal sterilization: a randomized controlled trial. Contraception 2012; 85:275-81. [DOI: 10.1016/j.contraception.2011.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/30/2011] [Indexed: 10/17/2022]
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Köşüş N, Köşüş A, Güler A, Simavli SA, Turhan NÖ. Transcervical intrauterine levobupivacaine infusion or paracervical block for pain control during endometrial biopsy. Exp Ther Med 2012; 3:683-688. [PMID: 22969951 DOI: 10.3892/etm.2012.463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/19/2011] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to determine pain during endometrial biopsy by comparing the use of intrauterine instillation of levobupivacaine or paracervical block with a placebo in a randomized, double-masked trial in premenopausal and postmenopausal women. A total of 90 women were enrolled in the study. Patients were allocated to either the control or case groups. Group 1 consisted of 30 cases with intrauterine anesthesia with 5 ml 0.5% levobupivacaine. Group 2 consisted of 30 patients who underwent paracervical block with lidocaine. No analgesic agent was given to the remaining 30 patients; these cases comprised the control group. The primary outcome measures were pain or discomfort experienced during the procedure. When the pain scores of the different groups were compared, the scores in the intrauterine levobupivacaine and paracervical block groups were found to be significantly lower compared to those in the control group. There was no difference between the levobupivacaine and paracervical block groups in terms of pain scores. There was a marked positive correlation between biopsy indications and pain scores. Pain scores were lower in cases with the indication of polymenorrhea, hypermenorrhea and metrorraghia compared to those in the cases with other indications. In conclusion, the transcervical intrauterine instillation of levobupivacaine or paracervical block with lidocaine brings about pain relief during and after endometrial biopsy.
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Affiliation(s)
- Nermin Köşüş
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara
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Yilmazer M, Kose S, Arioz DT, Koken G, Ozbulut O. Efficacy of transcutaneous electrical nerve stimulation for pain relief in women undergoing office endometrial biopsy. Arch Gynecol Obstet 2011; 285:1059-64. [DOI: 10.1007/s00404-011-2111-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/04/2011] [Indexed: 10/16/2022]
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Dunivan GC, Parnell BA, Connolly A, Jannelli ML, Horton BJ, Geller EJ. Bupivacaine injection during midurethral sling and postoperative pain: a randomized controlled trial. Int Urogynecol J 2011; 22:433-8. [DOI: 10.1007/s00192-011-1362-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Accepted: 01/14/2011] [Indexed: 11/30/2022]
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Comparison of oral nonsteroidal analgesic and intrauterine local anesthetic for pain relief in uterine fractional curettage: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol 2010; 203:28.e1-7. [PMID: 20435293 DOI: 10.1016/j.ajog.2010.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 12/02/2009] [Accepted: 02/10/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We sought to investigate the analgesic efficacy of oral dexketoprofen trometamol and intrauterine lidocaine in patients undergoing fractional curettage. STUDY DESIGN A randomized, double-blind, placebo-controlled trial was conducted on 111 women. Subjects were randomly assigned into 4 groups to receive either 25 mg of dexketoprofen or similar-appearing placebo tablets and either 5 mL intrauterine 2% lidocaine or saline. The main outcome measure was the intensity of pain measured by a 10-cm visual analog scale. Pain scoring was performed prior to, during, and 30 minutes after the procedure. RESULTS No statistically significant difference was found among the mean pain scores of women during the procedure in the dexketoprofen and saline, placebo and lidocaine, and dexketoprofen and lidocaine groups. The mean pain scores in all 3 groups revealed significant reduction when compared with placebo and saline combination (P = .001). CONCLUSION Administration of intrauterine lidocaine or oral dexketoprofen appears to be effective in relieving fractional curettage associated pain. However, a combination of them does not work better in further reduction of pain.
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MIZRAK A, UGUR GM, ERDALOGLU P, BALAT O, ONER U. Intra-uterine bupivacaine and levobupivacaine. Aust N Z J Obstet Gynaecol 2010; 50:65-9. [DOI: 10.1111/j.1479-828x.2009.01109.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Güler A, Sahin HG, Küçükaydın Z, Erdemoğlu E. Comparison of the efficacy of intrauterine lidocaine, paracervical block and oral etodolac for decreasing pain in endometrial biopsy. J Turk Ger Gynecol Assoc 2010; 11:178-81. [PMID: 24591932 DOI: 10.5152/jtgga.2010.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 11/14/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of paracervical block, intrauterine lidocaine and oral etodolac in decreasing the pain caused by pipelle endometrial sampling. A secondary goal of this study was to determine the adverse effects and compare possible effects of these methods on pulse and blood pressure. MATERIAL AND METHODS The study was performed between April 2006 and October 2006 in the Obstetrics and Gynecology Department of Van Yüzüncü Yıl University Research Hospital. One-hundred twenty patients were randomized into four groups: 1. Group: Paracervical block was performed with 3 ml 2% prilocaine solution. 2. Group: Five ml of 2% lidocaine solution was instilled through the endocervix into the uterine cavity. 3. Group: Subjects received 400 mg oral etodolac tablet 1-1.5 hour before the procedure. 4. Group: No method of anesthesia was used in the control group. Endometrial sampling was performed with pipelle. Severity of pain during the procedure was scored by the subjects according to the "6-point Verbal Rating Scale (VRS)". Blood pressure and pulse rate were measured before, during and 30 minutes after the procedure. RESULTS Pain scores in intrauterine lidocaine group (2(nd) group) were found statistically significantly lower than the other three groups (p<0.05). CONCLUSION Intrauterine lidocaine anesthesia technique decreases pain in endometrial sampling with pipelle more efficiently than paracervical block or oral etodolac. While indication of menorrhagia and endometrial thickness more than 5 mm increased pain scores, intrauterine lidocaine application or paracervical block decreased the scores significantly (p<0.05).
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Affiliation(s)
- Ayşe Güler
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - H Güler Sahin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Zehra Küçükaydın
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Evrim Erdemoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Randomized Trial of Oral Misoprostol Before Endometrial Biopsy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:1054-1059. [DOI: 10.1016/s1701-2163(16)34351-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Api O, Unal O, Ugurel V, Emeksiz MB, Turan C. Analgesic efficacy of intravenous paracetamol for outpatient fractional curettage: a randomised, controlled trial. Int J Clin Pract 2009; 63:105-11. [PMID: 18422592 DOI: 10.1111/j.1742-1241.2008.01751.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To determine the efficacy of intravenous (i.v.) paracetamol for decreasing pain associated with fractional curettage. MATERIALS AND METHODS This double-blind, randomised, placebo-controlled trial included 70 women who underwent fractional curettage. Patients were randomly assigned to receive i.v. infusion of either 1000 mg paracetamol (n = 36) or 0.9% normal saline as placebo (n = 34) prior to the procedure. The main outcome measure was the intensity of pain assessed by a 10-cm visual analogue scale. Pain scoring was performed at t(1) = prior to the procedure, t(2) = during the procedure and t(3) = 30 min after the procedure. Statistical analysis was performed using the Student's t-test, chi-squared and Pearson's correlation analysis. RESULTS The pain scores at t(2) and t(3) were significantly higher than the score at t(1) in both groups. There was no statistically significant difference between the pain scores at t(1), t(2) and t(3) among the two groups. Menopausal status had no effect on the pain scores and on the treatment outcome. The pain scores prior to the procedure were significantly higher in women with a history of endometrial curettage when compared with women who have no history. CONCLUSIONS Fractional curettage is associated with mild pain. We were unable to detect a significant difference in pain scores in patients undergoing fractional curettage when comparing the use of i.v. paracetamol with placebo. History of prior endometrial curettage seems to be a predictor of the basal pain scores at admission although it does not affect the pain intensity related to the procedure.
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Affiliation(s)
- O Api
- Department of Obstetrics & Gynecology, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey.
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Guney M, Oral B, Bayhan G, Mungan T. Intrauterine lidocaine infusion for pain relief during saline solution infusion sonohysterography: a randomized, controlled trial. J Minim Invasive Gynecol 2007; 14:304-10. [PMID: 17478360 DOI: 10.1016/j.jmig.2007.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 02/02/2007] [Accepted: 02/10/2007] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To evaluate the efficacy of intrauterine lidocaine instillation in reducing patient discomfort during saline solution infusion sonohysterography (SIS). DESIGN A double-blinded, randomized, controlled trial (Canadian Task Force classification I). SETTING Suleyman Demirel University School of Medicine, Department of Obstetrics and Gynecology, Isparta. PATIENTS One hundred-six women who underwent SIS. INTERVENTIONS Fifty-three patients were allocated to the lidocaine group and 53 to the saline solution group. MEASUREMENTS AND MAIN RESULTS The main outcome measures were the intensity of pain during, immediately after, and 20 minutes after the procedure, assessed by a visual analog scale and the patients' distress evaluated by the physician with a 3-point observer scale. There were no statistically significant differences between the study group and the control group in mean age, parity, past cervical surgery, history of chronic pelvic pain and dysmenorrhea, history of curettage, education, socioeconomic status, menopausal status, volume of saline solution infused (mL), tenaculum use, and indication for SIS. Pain scores demonstrated a statistically significant difference between groups during the procedure (placebo 5.09 +/- 1.25 [95% CI 4.74-5.43], lidocaine 3.90 +/- 1.02 [95% CI 3.61-4.18], p <.001); immediately after procedure (placebo 4.03 +/- 0.89 [95% CI 3.78-4.27], lidocaine 3.16 +/- 0.67 [95% CI 2.97-3.34], p <.001); and 20 minutes after procedure (placebo 3.32 +/- 0.54 [95% CI 3.17-3.46], lidocaine 2.43 +/- 0.72 [95% CI 2.23-2.62], p <.001). No significant pain relief in nulliparous patients was obtained by the use of lidocaine (4.88 +/- 1.01 [95% CI 4.60-5.15], 3.88 +/- 0.86 [95% CI 3.64-4.11], 3.22 +/- 0.55 [95% CI 3.06-3.37], respectively; p >.05). Pain rated by the physician during, immediately after, and 20 minutes after the procedure was significantly different between the groups (p <.001), and a significant correlation was noted between the visual analog pain score and the patients' distress recorded by the physician (r = 0.816, r = 0.697, r = 0.676; p <.001, respectively). CONCLUSION Intrauterine lidocaine seems to be effective in decreasing pain in parous women undergoing SIS.
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Affiliation(s)
- Mehmet Guney
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
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Güney M, Oral B, Mungan T. Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy. Int J Gynaecol Obstet 2007; 97:125-8. [PMID: 17316648 DOI: 10.1016/j.ijgo.2006.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 11/14/2006] [Accepted: 11/17/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy of intrauterine lidocaine plus buccal misoprostol in reducing the discomfort caused by endometrial biopsy with a suction curette. METHODS In this double-blind, randomized, placebo-controlled trial 126 women undergoing endometrial biopsy were administered a 200-microg tablet of misoprostol buccally, followed by a 5-mL uterine instillation of either of 2% lidocaine or a saline solution. The main outcome measures were the intensity of pain during, immediately following, and 20 min following the biopsy, as assessed on a 10-cm visual analog scale. Statistical analysis was performed using the Friedman test with the Bonferroni correction, the t test, and the chi(2) test. RESULTS There were no statistically significant differences between the study and control groups in mean age, parity, or relevant medical history. A statistically significant difference in pain scores was noted in premenopausal women during the procedure (lidocaine, 4.93+/-1.67; placebo, 6.17+/-1.26; P<0.001) as well as immediately later (lidocaine, 4.12+/-1.14 vs. placebo, 5.42+/-1.08; P<0.001) and 20 min later (lidocaine, 3.60+/-1.10; placebo, 4.22+/-1.46; P<0.001). No significant differences in pain scores were observed in postmenopausal women for any of the 3 time points (6.72+/-2.01, 5.18+/-1.22, and 4.56+/-0.80, respectively; P>0.05). The number needed to treat was 2.6 (95% confidence interval, 1.9-4.8). CONCLUSION Intrauterine lidocaine plus buccal misoprostol appears to be effective in decreasing pain in premenopausal women undergoing endometrial biopsy with a suction curette.
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Affiliation(s)
- M Güney
- Department of Obstetrics and Gynecology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey.
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Güney M, Oral B, Mungan T. Efficacy of Intrauterine Lidocaine for Removal of a “Lost” Intrauterine Device. Obstet Gynecol 2006; 108:119-23. [PMID: 16816065 DOI: 10.1097/01.aog.0000223201.42144.80] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of intrauterine lidocaine instillation in reducing patient discomfort during the removal of a "lost" intrauterine device (IUD). METHODS This double-blinded, randomized, placebo-controlled trial included 68 women who underwent removal procedure for a "lost" IUD. Thirty-four women were allocated to the lidocaine group and 34 to the saline group. The main outcome measure was the intensity of pain during, immediately after, and 20 minutes after the procedure, assessed by a visual analog scale. Statistical analysis was performed using the Friedman test with Bonferroni correction, Student t test, and chi2. RESULTS There were no statistically significant differences between the study group and the control group in mean age, parity history of chronic pelvic pain and dysmenorrhea, history of curettage, education, socioeconomic status, menopausal status, breastfeeding, type of IUD, and duration of IUD. Pain scores demonstrated a significant difference between groups during the procedure (placebo 6.41 +/- 1.15, lidocaine 5.23 +/- 0.69, P < .01), immediately after procedure (placebo 6.05 +/- 1.01, lidocaine 4.94 +/- 0.60, P < .01), and 20 minutes after procedure (placebo 4.32 +/- 0.63, lidocaine 4.44 +/- 0.66, P < .01). The number needed to treat was 3 (95% confidence interval 2-9). CONCLUSION Intrauterine lidocaine appears to be effective in decreasing pain in women undergoing the removal procedure of a "lost" IUD. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT00308841. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Mehmet Güney
- Department of Obstetrics and Gynecology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey.
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Edelman A, Nichols MD, Leclair C, Jensen JT. Four Percent Intrauterine Lidocaine Infusion for Pain Management in First-Trimester Abortions. Obstet Gynecol 2006; 107:269-75. [PMID: 16449111 DOI: 10.1097/01.aog.0000194204.71925.4a] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the effects of a 4% intrauterine lidocaine infusion on perceived patient pain in first-trimester abortions. METHODS A randomized, double-blind, placebo-controlled trial of 80 women receiving either a 5-mL 4% lidocaine (n = 40) or saline (n = 40) intrauterine infusion and a standard paracervical block before first-trimester abortion. Women completed a series of 100-mm visual analog scales (anchors: 0 = none, 100 mm = worst imaginable) to measure their perceived pain (anticipated pain, after speculum insertion, after intrauterine infusion, after cervical dilation, after suction aspiration, and 30 minutes postprocedure). Eight women volunteered for serum lidocaine levels after the lidocaine infusion. RESULTS Groups were similar in respect to age, parity, prior abortion, ethnicity, gestational age, and level of dysmenorrhea. Pain scores demonstrated a significant difference between groups during cervical dilation (saline 55 mm +/- 26, lidocaine 35 mm +/- 30, P < .01) and during aspiration (saline 71 mm +/- 20, lidocaine 43 mm +/- 30, P < .01). The lidocaine group reported significantly more symptoms (ie, oral numbness and tingling) than the saline group (saline 0/39, lidocaine 16/38, 42%, P < .01). The highest serum lidocaine level recorded was 4.0 microg/mL (lidocaine group). There was no difference in overall satisfaction between the 2 groups. CONCLUSION Compared with paracervical block alone, the addition of a 4% intrauterine lidocaine infusion resulted in a significant reduction in patient perception of pain during first-trimester abortion. Although subjective symptoms of systemic lidocaine effect were common, no subjects demonstrated serum levels consistent with lidocaine toxicity. However, further studies to determine safety are needed. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Alison Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, 97239, USA.
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Rattanachaiyanont M, Leerasiri P, Indhavivadhana S. Effectiveness of Intrauterine Anesthesia for Pain Relief During Fractional Curettage. Obstet Gynecol 2005; 106:533-9. [PMID: 16135583 DOI: 10.1097/01.aog.0000172424.09992.3e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the effectiveness of intrauterine anesthesia for pain relief during fractional curettage. METHODS A double-blinded, randomized, placebo-controlled trial was conducted in 66 patients with abnormal uterine bleeding undergoing fractional curettage under paracervical block, using 10-mL 1% lidocaine plus intrauterine 5-mL 2% lidocaine (n = 33) or saline (n = 33). The primary outcome was the maximum pain score measured with a 10-cm visual analog scale. Other outcomes measured included pain profile, number of patients with pain score more than 4, each patient's global satisfaction index, adverse events, and serum lidocaine profile. RESULTS The 2 groups were comparable in age, body mass index, education, socioeconomic status, menopausal status, and parity. Compared with the saline group, the lidocaine group had a significantly lower median value for the maximum pain score (2.3 versus 4.7, P = .022) and fewer patients with a pain score more than 4 (33.3% versus 60.6%, P = .026). The pain scores were lower at the endocervical curettage and the uterine curettage steps. There was no difference between the 2 groups in other outcomes. The number needed to treat to prevent a case with a pain score more than 4 was 3.7 (95% confidence interval 2.4-38.5). CONCLUSION The addition of intrauterine anesthesia to paracervical block can further reduce pain during fractional curettage without increasing adverse effects. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Manee Rattanachaiyanont
- Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.
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Abstract
OBJECTIVE To estimate whether benzocaine spray applied to the cervix and the endocervical canal before performing office endometrial biopsy improves patient comfort during the procedure. METHODS Eighty-eight women were randomly assigned to receive either 20% benzocaine spray or placebo to the outside of the cervix and into the endocervical canal before an endometrial biopsy was performed. The main outcome measure was pain during the endometrial biopsy, assessed by a visual analog scale. Statistical analysis was performed using Wilcoxon rank-sum test and Student t test. RESULTS There were no statistically significant differences between the study group and the control group in mean age, race, parity, body mass index, menopausal status, tenaculum use, or history of chronic pelvic pain. No statistically significant differences were found in median pain scores between the 2 treatment groups. CONCLUSION Topical benzocaine spray does not appear to offer effective pain control in patients undergoing an endometrial biopsy. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Jon I Einarsson
- Department of Obstetrics and Gynecology, Landspitali-University Hospital, Reykjavik, Iceland.
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