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Obstetrics & Gynecology 2007;109:89-93
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Intracervical Block and Pain Perception During the Performance of a Hysterosalpingogram

A Randomized Controlled Trial

Randal D. Robinson, MD, Yovanni Casablanca, MD, Katherine E. Pagano, MD, Nancy A. Arthur, RN, G. Wright Bates, MD and Anthony M. Propst, MD

From the Department of Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, Wilford Hall Medical Center, Lackland Air Force Base, Texas; Brooke Army Medical Center, Fort Sam Houston, Texas.

OBJECTIVE: To estimate whether an intracervical block of 1% lidocaine decreased pain perception compared with placebo during the performance of a hysterosalpingogram.

METHODS: A randomized controlled trial was conducted with 120 patients assessing pain perception during a hysterosalpingogram. Patients were randomly assigned to one of three groups. Patients received either a 1% lidocaine intracervical block, an intracervical saline injection, or no injection. Visual analog (VAS) and qualitative scales were used to assess study participants' pain at six different time points during the hysterosalpingogram.

RESULTS: Subjects receiving the lidocaine block had significantly less pain (P<.001) by VAS during tenaculum placement (approximately 61% less, 1.303 cm) and with tenaculum traction (approximately 40% less, 2.804 cm) compared with both the intracervical saline injection group and the no injection group (tenaculum placement, 3.384 cm and 3.354 cm, and tenaculum traction, 4.705cm and 4.961 cm, respectively). There was no improvement seen with pain perception during instillation of the contrast in the lidocaine group compared with the saline or no injection group (P<.073). Subjects who received the saline injection had statistically more pain (P<.001) by VAS (2.647 cm) immediately after the injection compared with the lidocaine (approximately 79% greater, 1.476 cm) and no injection groups (115% greater, 1.232 cm).

CONCLUSION: Lidocaine intracervical block provides better pain relief than placebo during tenaculum placement and tenaculum traction during a hysterosalpingogram. This study suggests that patients should be offered an intracervical block before placement of the cervical tenaculum to decrease pain during the performance of a hysterosalpingogram.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00372658

LEVEL OF EVIDENCE: I






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