1817 is Paracervical Block Useful to Decrease Pain During in Office?

Abstract

Study Objective To determine if paracervical block significantly decreases pain during in-office hysteroscopy. Design Retrospective chart review. Setting Gynecologic in-office procedure room in an academic medical center. Patients or Participants Patient undergoing in office hysteroscopy. Interventions In office hysteroscopy was performed using a STORZ Bettocchi hysteroscope with continuous flow using a 5 mm external sheet and a 30o 2.9 mm optic. All the procedures were performed by the same physician. Measurements and Main Results 50 patient's charts were reviewed, 21 received a paracervical block and 29 did not receive any local anesthesia. Of the 21 that received the block, mean age was 46.1 years, 27.6% were nulliparous, 24.1% were postmenopausal. Of the 29 patients who received no local anesthesia, mean age was 46.9 years (p=0.783), 48.3% were nulliparous, 27.6% were postmenopausal. In both groups, the most common reasons for hysteroscopy were abnormal uterine bleeding (AUB). Pain was recorded for all patients immediately after finalizing the procedure using a Likert-like scale from 1 to 10. The average pain score for the patients who received the paracervical block was 3.48 compared to 4.07 in those not having the block (p=0.348). Neither obesity nor nulliparity were found to be associated with increased pain, however postmenopausal women overall were found to have higher reported pain (p=0.013.). If given a paracervical block, mean pain in postmenopausal women was 4.29 compared to 6.00 without block (p=.215.). Conclusion Hysteroscopy as a safe and relatively low pain procedure. Local anesthetic in the form of a paracervical block has been used historically to decrease pain during the procedure. Paracervical block does not significantly decrease pain during procedure, even in menopausal women who were found to have higher pain scales on average. Therefore, future studies should further investigate strategies to decrease pain during office hysteroscopy especially for postmenopausal women.