Lidocaine Gel Combined with Ibuprofen Versus Ibuprofen Alone for Pain Relief during an Endometrial Biopsy; A randomized controlled trial
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Abstract
Objectives: To study the effect of 2% lidocaine gel in conjunction with ibuprofen for pain relief during endometrial biopsy.
Materials and Methods: Women who met the eligibility criteria were randomly allocated into two groups. The intervention group received 2% lidocaine gel (3 mL), while the control group received the placebo gel (3 mL). Both groups received oral ibuprofen 400 mg 30 minutes before the procedure. The pain score in each step of the procedure, starting from speculum insertion, grasping the cervix, during endometrial biopsy, immediately after the procedure, and 10 minutes after the procedure, was assessed by a 10-cm visual analogue scale. Any adverse effects were also recorded.
Results: Eighty-six women, 43 in each group, were recruited during July to December 2024. Baseline characteristics, including age, parity, and menopausal status, were not different in both groups. The mean pain score during endometrial biopsy in the intervention group (3.30 ± 2.09) was significantly lower than in the control group (5.33 ± 2.01) (mean difference -2.03, 95% confidence interval -2.91 to -1.15, p < 0.001). Pain scores at each step of the procedure in the intervention group were lower than in the control group but not statistically different. Adverse effects were not found, and the satisfaction of both patients and physicians was satisfied.
Conclusion: The addition of 2% lidocaine gel was effective in reducing pain during endometrial biopsy when compared to ibuprofen alone.
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References
American College of Obstetricians and Gynecologists. Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol 2019;133:e148–59.
Rindfleisch K, Falleroni J, Schrager S. Abnormal uterine bleeding in reproductive-aged women. J Clin Outcomes Manag 2015;22:83–94.
Khomphaiboonkij U, Jarruwale P. Accuracy of pre-operative endometrial sampling for the detection of high grade endometrial cancer. Thai J Obstet Gynaecol 2015;23:158–64.
Suwanwanich M. Risk assessment of endometrial hyperplasia and cancer in premenopausal women with abnormal uterine bleeding. Thai J Obstet Gynaecol 2024;32:149–55.
Berek JS, Hillard PJA, editors. Berek & Novak’s gynecology. 16th ed. Philadelphia: Wolters Kluwer Health; 2012.
Gou J, Li ZY. Accuracy of endometrial biopsy by Pipelle: a systematic review and meta-analysis. Ann Oncol 2019;30:ix84–5.
Charoenkwan K, Nantasupha C. Methods of pain control during endometrial biopsy: a systematic review and meta-analysis of randomized controlled trials. J Obstet Gynaecol Res 2020;46:9–30.
Tanprasertkul C, Pongrojpow D. Efficacy of etoricoxib for pain relief during endometrial biopsy: a double blind randomized controlled trial. J Med Assoc Thai 2008;91:13–8.
Yaron M, Legardeur H, Barcellini B, Akhoundova F, Mathevet P. Safety and efficacy of a suction cervical stabilizer for intrauterine contraceptive device insertion: results from a randomized controlled study. Contraception 2023;123:110004.
Goldthwaite LM, Baldwin MK, Page J, Micks EA, Nichols MD, Edelman AB, et al. Comparison of interventions for pain control with tenaculum placement: a randomized clinical trial. Contraception 2014;89:229–33.
Liberty G, Gal M, Halevy-Shalem T, Michaelson-Cohen R, Galoyan N, Hyman J, et al. Lidocaine-prilocaine (EMLA) cream as analgesia for hysterosalpingography: a randomized controlled trial. Hum Reprod 2007;22:1335–9.
Davies A, Tom MA, Baskett F, Robert MB, Richardson E, Nagele F, et al. Analgesia for outpatient hysteroscopy: a randomized controlled trial. Fertil Steril 1997;67:1019–42.
S omchit W, Lertkhachonsuk AA, Vallipakorn SAO. Naproxen for pain relief during endometrial biopsy: a randomized controlled trial. J Med Assoc Thai 2015;98:631–5.
Karaca I, Yapca OE, Adiyeke M, Toz E, Karaca SY. Effect of cervical lidocaine gel on pain during Pipelle endometrial sampling. Eurasian J Med 2016;48:189–91.
Kozman E, Collins P, Howard A, Akanmu T, Gibbs A, Frazer M. The effect of intrauterine 2% lignocaine gel on pain perception during Vabra endometrial sampling: a randomized trial. BJOG 2001;108:87–90.
Likkasittipan N, Wiriyasirivaj B. Effect of lidocaine gel for pain relief during endometrial sampling: a randomized controlled trial. Thai J Obstet Gynaecol 2021;29:273–80.
Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol 2016;34:54–65.
Farzaneh F, Ashtiani AJ, Hashemi M, Hosseini MS, Arab M, Ashrafganjoei T, et al. Endometrial cancer in women with abnormal uterine bleeding: data mining classification methods. Caspian J Intern Med 2023;14:526–33.
Unlu BS, Yilmazer M, Koken G, Arioz DT, Unlu E, Baki ED, et al. Comparison of four different pain relief methods during hysterosalpingography: a randomized controlled study. Pain Res Manag 2015;20:107–11.
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.
Sripha P, Phaliwong P. Effectiveness of lidocaine spray in reducing pain during cervical manipulation: a randomized controlled trial. Thai J Obstet Gynaecol 2018;26:190–7.
Korsuwan P, Wiriyasirivaj B. Lidocaine spray for pain control during office-based endometrial biopsy: a randomized placebo-controlled trial. Thai J Obstet Gynaecol 2018;26:262–9.
Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006;15 Suppl 1:S17–24.
Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage 2011;41:1073–93.
Visser NCM, Breijer MC, Herman MC, Bekkers RLM, Veersema S, Opmeer BC, et al. Factors attributing to the failure of endometrial sampling in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 2013;92:1216–22.
