Intracervical Block and Pain Perception During the Performance of a Hysterosalpingogram: A Randomized Controlled Trial

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...

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Bibliographic Details
Published in:	Obstetrics and gynecology (New York. 1953) Vol. 109; no. 1; pp. 89 - 93
Main Authors:	Robinson, Randal D, Casablanca, Yovanni, Pagano, Katherine E, Arthur, Nancy A, Bates, G Wright, Propst, Anthony M
Format:	Journal Article
Language:	English
Published:	New York, NY by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01-01-2007 Elsevier Science
Subjects:	Adult Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Local - administration & dosage Anesthetics, Local - therapeutic use Biological and medical sciences Cervix Uteri - drug effects Female General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation Gynecology. Andrology. Obstetrics Humans Hysterosalpingography - adverse effects Lidocaine - administration & dosage Lidocaine - therapeutic use Medical sciences Pain - drug therapy Pain - etiology Performance evaluation Human Pain Radiodiagnosis Gynecology Local anesthesia Randomised controlled trial Medical imagery Block Perception Uterine cervix Hysterosalpingography
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Summary:	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 participantsʼ 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
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0029-7844 1873-233X
DOI:	10.1097/01.AOG.0000247645.52211.41