Intrauterine lidocaine infusion for pain relief during saline solution infusion sonohysterography: A randomized, controlled trial

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.