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.
Highlights
Abnormal vaginal bleeding is a common presenting complaint of women aged 35 years or more at the gynecology clinic
Another advantage of the Novak curette is that, during the procedure, the patient does not require general anesthesia or deep sedation, and the procedure is available in the outpatient department and no admission is required
This study showed that the number of patients in the severe pain group was significantly lower in the intervention arm using lidocaine spray compared to placebo in three measurements, during the application of the tenaculum and the insertion of the Novak curette and during tissue aspiration
Summary
Abnormal vaginal bleeding is a common presenting complaint of women aged 35 years or more at the gynecology clinic It is a major cause of distress for patients as well as a sign of a serious gynecological condition. The Novak endometrial curette is reusable and obtains an adequate amount of tissue for pathological examinations, even while the patient has bleeding. The gynecologist could choose the appropriate size of the Novak curettage to suit each individual patient. Another advantage of the Novak curette is that, during the procedure, the patient does not require general anesthesia or deep sedation, and the procedure is available in the outpatient department and no admission is required. Even in patients who experience heavy vaginal bleeding, the Novak
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