Comparison of the intrauterine topical anaesthesia and paracervical block on pain in patients undergoing endometrial biopsy

Abstract

Objective: To evaluate the efficacy and safety of topical endometrial anaesthesia during endometrial biopsy and compare it with standard paracervical block. Methods: 114 women in reproductive period undergoing endometrial biopsy for abnormal uterine bleeding were enrolled into this study. Women were randomly assigned into four groups to receive different anaesthetics. Group A (placebo group) received intrauterine placebo; Group B received intrauterine lidocaine hydrochloride solution; Group C received paracervical injection of 1 : 1 diluted lidocaine solution alone and Group D received intrauterine topical anaesthesia in addition to paracervical block. All patients were asked by the nurse to rate the intensity of pain on a 0-100 mm scale (VAS) during the application of the anaesthetic (T1), cervical dilation (T2) (if needed), endometrial biopsy (T3) and 15 minutes after the procedure (T4). Results: All groups were similar in medical and demographic characteristics. The mean pain intensity scored on VAS in groups C and D was significantly higher than in groups A and B at T1 and lower at T3 and T4 (p < 0.05). On the other hand, considering only the patients who did not need cervical dilation during the procedure, there was not any significant difference on the pain experienced at T3 and T4. Conclusions: Intrauterine anaesthesia is not better than the other anesthetic techniques and has no additive effect on conventional paracervical block in reducing the pain during endometrial biopsy, but it is effective in reducing the occurrence of vasovagal reaction.