A randomized trial comparing local intracervical and combined local and paracervical anesthesia in outpatient hysteroscopy

Abstract

Study objective To compare the amount of pain during and after hysteroscopy using local intracervical and combined local and paracervical anesthesia. Design Prospective randomized trial (Canadian Task Force classification I). Setting University teaching hospital. Patients Eighty-four women who underwent outpatient hysteroscopy for evaluation of the uterine cavity at McGill University Health Center. Interventions Randomization to local intracervical or combined local and paracervical anesthesia. Measurements and main results Amount of pain experienced during the procedure and at 10, 30, and 60 minutes after the procedure was measured using a visual analog scale ranging from zero to 10 (zero = no pain; 10 = excruciating pain). The mean age of the patients in the local anesthesia group was 36.1 ± 0.7 years and in the combined local and paracervical anesthesia group was 35.2 ± 0.7 years. Patients experienced significantly more pain during than after the procedure. The mean pain scores in the local anesthesia group were significantly higher than in the combined anesthesia group during the procedure (3.2 ± 0.3 vs 2.1 ± 0.2; p <.01; 95% CI 0–2), 10 minutes after the procedure (1.9 ± 0.2 vs 1.5 ± 0.3; p = .03; 95% CI 0–1), and 30 minutes after the procedure (1.7 ± 0.2 vs 1.0 ± 0.2; p = .02; 95% CI 0–1). However, there was no significant difference in pain scores at 60 minutes after the procedure between the local anesthesia and combined anesthesia groups (0.9 ± 0.2 and 0.7 ± 0.1, respectively). Conclusions Outpatient hysteroscopy with local or combined local and paracervical anesthesia was well tolerated by patients. However, combined anesthesia was associated with less pain during and at 10 and 30 minutes after the procedure. Most patients considered the pain as mild.