Intrauterine lidocaine reduces pain during, after hysteroscopy-guided biopsy

Key takeaways:

• Intrauterine lidocaine significantly reduced pain during and after hysteroscopy-guided biopsy compared with placebo.
• There were no adverse effects associated with intrauterine lidocaine.

DENVER — Women undergoing endometrial biopsy using vaginoscopic hysteroscopy reported less pain and were discharged sooner when the procedure was performed with intrauterine lidocaine compared with placebo, researchers reported.

Office hysteroscopy is widely used for diagnosing and treating intrauterine pathologies for women with abnormal uterine bleeding and is usually performed without analgesia, Aishwarya T P, MBBS, MS, senior resident in obstetrics and gynecology at Jawaharlal Institute of Postgraduate Medical Education and Research in Puducherry, India, said during a presentation at the ASRM Scientific Congress & Expo.

“Pain has been stated as the most common reason for canceling the hysteroscopic procedure or failure of the procedure,” T P said. “Even though hysteroscopy is very popular, there are no precise guidelines regarding anesthesia or analgesia for diagnostic hysteroscopy.”

For the double-blind, randomized controlled trial, researchers analyzed data from 126 women scheduled for outpatient hysteroscopy-guided biopsy from 2021 to 2022. Researchers randomly assigned participants to lidocaine 2% (n = 63; mean age, 44 years) or placebo (saline; n = 63; mean age, 46 years). For this study, surgeons used an intrauterine insemination catheter to administer the saline or lidocaine, with hysteroscopy performed 5 minutes later.

“This is the first study to compare intrauterine lidocaine with placebo in vaginoscopic hysterectomy-guided biopsies,” T P said. “It involved premenopausal and postmenopausal patients; most trials we have seen have only been [conducted with] premenopausal women.”

Researchers assessed pain at hysteroscope insertion, during hysteroscopic guided biopsy and again at 10, 30 and 60 minutes after the biopsy, using the visual analog scale (VAS) score ranging from 0 to 10, with 10 indicating the worst pain. Researchers also measured blood pressure and pulse rate and recorded any signs of lidocaine toxicity. Researchers observed participants for 60 minutes in a recovery room after the procedure.

Among the 126 biopsies performed, 61.1% were for abnormal uterine bleeding, 27.78% were for postmenopausal bleeding, 5.56% were for infertility cases and 5.56% cases were for bad obstetric history.

The VAS scores on insertion of hysteroscope, during biopsy, and at 10, 30 and 60 minutes after biopsy showed significant between-group differences, with the lidocaine group reporting less pain (P = .001).

Mean VAS scores for the lidocaine and placebo groups, respectively, were:

• 2 vs. 4 during the hysteroscope insertion (mean difference, 1.89);
• 4 vs. 5 during biopsy (mean difference, 1.86);
• 2 vs. 4 10 minutes after the procedure (mean difference, 1.79);
• 1 vs. 3 30 minutes after the procedure (mean difference, 1.78); and
• 0 vs. 1 60 minutes after the procedure (mean difference, 1.25).

“The pain was significantly less in the intervention arm than the placebo arm,” T P said.

Participants in the lidocaine group had improved ambulation and discharge times compared with those who received placebo, T P said, with improved mean ambulation times of 9.2 minutes vs. 15.87 minutes in the lidocaine vs. placebo groups (P < .001) and improved mean discharge times of 15 minutes vs. 30 minutes (P < .001).

Using a Likert scale to compare overall satisfaction with the procedure, 30.2% and 55.5% of lidocaine participants reported being very satisfied or satisfied, respectively, compared with 1.59% and 25.4% of placebo participants, T P said.