Effect of Lidocaine Gel for Pain Relief during Endometrial Sampling: A double-blinded randomized controlled trial

Main Article Content

Napat Likkasittipan
Budsaba Wiriyasirivaj

Abstract

Objective:  To investigate the effect of 2% lidocaine gel for pain relief during endometrial sampling procedures compared with placebo.


Materials and Methods: This double-blinded randomized, prospective, placebo-controlled study was performed at an out-patient gynecology clinic, tertiary teaching hospital, Bangkok, Thailand from September 2018 to April 2019. Sixty women who were indicated for endometrial tissue sampling were randomly assigned to either lidocaine group, which received 2% lidocaine gel 1 milliliter applied at cervical os and 2 milliliters pushed into cervical canal 3 minutes before the procedure, or placebo group which received placebo gel administered in the same manner. Pain scores, using 10 centimeter-visual analog scale, were assessed at baseline, when inserting the speculum, during Wallach Endocell® insertion, during endometrial aspiration, immediately after aspiration, and 10 minutes after procedure. Adverse symptoms and signs were also observed.


Results:  Mean pain score during endometrial aspiration was significantly lower in the lidocaine group (n=29) compared with placebo (n=29) (2.92 + 2.40 and 4.47 + 2.06, respectively; p-value = 0.011). Mean pain score at baseline, during Wallach Endocell® insertion, immediately after aspiration, and 10 minutes after procedure were not statistically significantly different between groups (1.52 ± 2.25, 3.13 ± 2.81, 1.89 ± 2.23, and 0.62 ± 1.32 in the lidocaine group, and 1.69 ± 2.07, 4.20± 2.35, 2.95± 2.33, and 0.93 ± 1.36 in the placebo group, respectively (p-value > 0.05)). There were no adverse symptoms and signs observed.


Conclusion:  The 2% lidocaine gel applied at the cervical surface and internal cervical canal was effective for pain relief during endometrial sampling.

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Article Details

Section
Original Article
Author Biography

Budsaba Wiriyasirivaj, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand

Department of Obstetrics and Gynaecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University

References

1. Cengiz H, Dagdeviren H, Kaya C, Yesil A, Caypinar SS. Comparing the efficacy of intrauterine lidocaine and paracervical block in decreasing the pain associated with endometrial biopsy: a randomised trial. Arch Gynecol Obstet 2014; 289:609-14.
2. Chambers JT, Chambers SK. Endometrial sampling: When? Where? Why? With What?. Clin Obstet Gynecol 1992; 35:29-39.
3. Dogan E, Celiloglu M, Sarihan E, Demir A. Anesthetic effect of intrauterine lidocaine plus naproxen sodium in endometrial biopsy. Obstet Gynecol 2004; 103:347-51.
4. Somchit W, Lertkhachonsuk AA, Vallipakorn SA. Naproxen for pain relief during endometrial biopsy: a randomized controlled trial. J Med Assoc Thai 2015; 98:631-5.
5. Guler A, Sahin HG, Kucukaydin Z, Erdemoglu E. Comparison of the efficacy of intrauterine lidocaine, paracervical block and oral etodolac for decreasing pain in endometrial biopsy. J Turk Ger Gynecol Assoc 2010; 11:178-81.
6. Aksoy H, Aksoy U, Ozyurt S, Acmaz G, Babayigit M. Lidocaine 10% spray to the cervix reduces pain during intrauterine device insertion: a double-blind randomised controlled trial. J Fam Plann Reprod Health Care 2016; 42:83-7.
7. Korsuwan P, Wiriyasirivaj B. Lidocaine spray for pain control during office-based endometrial biopsy: a randomized placebo-controlled trial. TJOG 2018; 26:262-9.
8. Kozman E, Collins P, Howard A, Akanmu T, Gibbs A, Frazer M. The effect of an intrauterine application of two percent lignocaine gel on pain perception during Vabra endometrial sampling: a randomised double-blind, placebo-controlled trial. BJOG 2001; 108:87-90.
9. Karaca I, Yapca OE, Adiyeke M, Toz E, Karaca SY. Effect of cervical lidocaine gel for pain relief in Pipelle endometrial sampling. Eurasian J Med 2016; 48:189-91.
10. Kaunitz AM, Masciello A, Ostrowski M, Rovira EZ. Comparison of endometrial biopsy with the endometrial Pipelle and Vabra aspirator. J Reprod Med. 1988; 33:427-31.
11. Kosus N, Kosus A, Demircioglu RI, Simavli SA, Derbent A, Keskin EA, et al. Transcervical intrauterine levobupivacaine or lidocaine infusion for pain control during endometrial biopsy. Pain Res Manag 2014; 19:82-6.
12. Damsbo N. Diagnosis vacuum aspiration curettage and biopsy without anaesthesia in general practice. Scand J Prim Health Care 1998; 6:225-7.
13. Wanijasombutti P, Imruetaicharoenchok A, Tangjitgamol S, Loharamtaweethong K, Phuriputt N, Phaloprakarn C. Comparison of tissue adequacy for histologic examination from Ipas MVA plus and Wallach Endocell in women with abnormal uterine bleeding. J Obstet Gynaecol Res 2015; 41:1246-54.
14. Wallace SL, Sokol ER. Anatomy and embryology. In: Berek JS, editor. Berek & Novak’s Gynecology. 16th ed. Philadelphia: Wolters Kluwer; 2020. p. 72-5.
15. Bant JS, Aman TK, Raman IM. Antagonism of lidocaine inhibition by open-channel blockers that generate resurgent Na current. J Neurosci 2013; 33:4976-87.