Comparing the efficacy of intrauterine lidocaine and paracervical block for decreasing pain in endometrial biopsy. ENDOMETRİYAL BİYOPSİ ANALJEZİSİNDE İNTRAUTERİN LİDOKAİN İLE PARASERVİKAL BLOK UYGULAMALARININ KIYASLANMASI.
Primary aim of this study was to compare the efficacy of paracervical block and intrauterine lidocaine in decreasing the pain caused by endometrial sampling, and to determine the adverse effects and compare possible effects of these methods on pulse and blood pressure.
The study was performed between April 2006 and October 2006 in Obstetrics and Gynecology department of Van Yüzüncü Yıl University Research Hospital. One-hundred and twenty patients who fulfilled the inclusion criteria and required endometrial biopsy to be taken for any indication were enrolled in the study. The subjects were randomized for paracervical block (1st group), intrauterine lidocaine (2nd group) and control (3rd group) groups. In the 1st group, paracervical block was performed with 3 ml 2% prilocaine solution. In the 2nd group, 5 ml of 2% lidocaine solution was instilled through the endo-cervix into the uterine cavity. In the 3rd group no methods of anelgesia was used. Endometrial sampling of all subjects was performed by the same person using pipelle endometrial sampling device. After completion of the procedure, but before the speculum was taken out, all patients were asked to score the severity of pain they felt during the procedure according to the “6-point Verbal Rating Scale (VRS)”. Blood pressures and pulse rates of all subjects were measured before, during and 30 minutes after the procedure. All subjects were observed in the clinic during the first hour after the procedure and were asked at the end of this time if they needed additional analgesia. Statistical analysis of data was performed using SPSS 13.0 for Windows package programme with Student’s-t test, Post-hoc LSD test, Chi-square test, One-way ANOVA and Spearman correlation analysis tests.
Ages of 90 subjects included in the study were between 20-67 and mean age was 46.1±9.3 years. There were no statistically significant differences in age, gravidity, parity, number of living children or menopausal status of the groups. When pain scores of groups were compared, scores in intrauterine lidocaine group (2nd group) were found statistically significantly lower than the other two groups (p>0.05) Also there was significant difference between the scores of paracervical block and control groups (p=0.004). Indication of endometrial biopsy, thickness of endometrium being less or more than 5 mm and, the method of anesthesia/analgesia that was used were all the factors which affected the pain scores. There was no statistically significant difference among groups in terms of blood pressure, pulse and additional analgesia requirement. No complications occurred in any of the subjects.
Intrauterine lidocaine anesthesia technique decreases pain in endometrial sampling with pipelle more efficiently than paracervical block. Intrauterine lidocaine anesthesia is painless and easy procedure for endometrial sampling with pipelle and can provide sufficient anesthesia without causing any complications.