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Effectiveness of Intrauterine Anesthesia for Pain Relief During Fractional Curettage

From the ¹Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.

Objective: To study the effectiveness of intrauterine anesthesia for pain relief during fractional curettage.

Methods: A double-blinded, randomized, placebo-controlled trial was conducted in 66 patients with abnormal uterine bleeding undergoing fractional curettage under paracervical block, using 10-mL 1% lidocaine plus intrauterine 5-mL 2% lidocaine (n = 33) or saline (n = 33). The primary outcome was the maximum pain score measured with a 10-cm visual analog scale. Other outcomes measured included pain profile, number of patients with pain score more than 4, each patient's global satisfaction index, adverse events, and serum lidocaine profile.

Results: The 2 groups were comparable in age, body mass index, education, socioeconomic status, menopausal status, and parity. Compared with the saline group, the lidocaine group had a significantly lower median value for the maximum pain score (2.3 versus 4.7, P = .022) and fewer patients with a pain score more than 4 (33.3% versus 60.6%, P = .026). The pain scores were lower at the endocervical curettage and the uterine curettage steps. There was no difference between the 2 groups in other outcomes. The number needed to treat to prevent a case with a pain score more than 4 was 3.7 (95% confidence interval 2.4–38.5).

Conclusion: The addition of intrauterine anesthesia to paracervical block can further reduce pain during fractional curettage without increasing adverse effects.

Level of Evidence: I

This article has been cited by other articles:

				M. Guney, B. Oral, and T. Mungan Efficacy of intrauterine lidocaine for removal of a "lost" intrauterine device: a randomized, controlled trial. Obstet. Gynecol., July 1, 2006; 108(1): 119 - 123. [Abstract] [Full Text] [PDF]

				Intrauterine Lidocaine Decreases Pain Associated with D&C Journal Watch Women's Health, November 1, 2005; 2005(1101): 4 - 4. [Full Text]