Hysteroscopic local anesthetic intrauterine cornual block in office endometrial ablation: a randomized controlled trial

• Published in: Fertility and sterility Vol. 105; no. 2; pp. 474 - 480.e1
• Main Authors: Kumar, Vinod, Ph.D, Tryposkiadis, Konstantinos, M.Sc, Gupta, Janesh Kumar, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2016
• Subjects: Adult; Ambulatory Surgical Procedures - adverse effects; Ambulatory Surgical Procedures - methods; Analgesics - therapeutic use; Anesthetics, Local - administration & dosage; Double-Blind Method; Endometrial Ablation Techniques - adverse effects; Endometrial Ablation Techniques - methods; Endometrium - innervation; Endometrium - surgery; England; Female; Heavy menstrual bleeding; Hospitals, University; Humans; Hysteroscopy - adverse effects; Internal Medicine; Length of Stay; Menorrhagia - diagnosis; Menorrhagia - surgery; Middle Aged; Nerve Block - methods; Obstetrics and Gynecology; office endometrial ablation; pain control; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Prospective Studies; Time Factors; Treatment Outcome; England; office endometrial ablation; Heavy menstrual bleeding; pain control
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2015.10.019

Objective To evaluate the efficacy of a hysteroscopic local anesthetic intrauterine cornual block (ICOB) on pain experienced during office endometrial ablation (EA) in addition to a traditional direct local anesthetic cervical block (DCB). Design Prospective, randomized, double-blind, placebo-controlled trial. Setting University teaching hospital. Patient(s) Women with heavy menstrual bleeding scheduled for an office endometrial ablation. Intervention(s) Before office EA, DCB plus hysteroscopic ICOB just medial to each tubal ostium using local anesthetic mixture made up of 1 mL 3% mepivacaine plus 1 mL 0.5% bupivacaine versus control group receiving DBC plus ICOB with 2 mL of placebo (saline). Main Outcome Measure(s) Primary outcome: pain reported during procedure via visual analogue scale (VAS) from 0 to 10; secondary outcomes: postoperative pain, rescue analgesic requirement, and duration of hospital stay. Result(s) Most characteristics were similar across groups. The mean VAS score during the procedure was statistically significantly lower by 1.44 (95% confidence interval, −2.65 to −0.21) in the active group compared with the placebo group. There were no statistically significant differences between the two groups in the postprocedural mean VAS scores, rescue analgesic requirement, or duration of hospital stay. Conclusion(s) Used in addition to DCB, ICOB reduces the pain experienced during office EA compared with DCB alone. Clinical Trial Registration Number NCT01808898.