A randomized trial comparing local intracervical and combined local and paracervical anesthesia in outpatient hysteroscopy. Use of sublingual buprenorphine for pain relief in office hysteroscopy. Two modalities of topical anesthesia for office hysteroscopy. Use of diclofenac as an analgesic in outpatient hysteroscopy: a randomized, double-blind, placebo-controlled study. A randomized trial of outpatient hysteroscopy with and without intrauterine anesthesia. Stepwise pain score analysis of the effect of local lignocaine on outpatient hysteroscopy: a randomized, double-blind, placebo-controlled trial. Outpatient hysteroscopy: a comparison of 2 methods of local analgesia. Paracervical anesthesia for outpatient hysteroscopy. Paracervical anesthesia for hysteroscopy and endometrial biopsy in postmenopausal women. A randomized, double-blind, placebo-controlled study. Outpatient operative hysteroscopy with bipolar electrode: a prospective multicentre randomized study between local anaesthesia and conscious sedation. Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy. Topical anaesthesia for diagnostic hysteroscopy and endometrial biopsy in postmenopausal women: a randomised placebo-controlled double-blind study. Feasibility and pain control in outpatient hysteroscopy in postmenopausal women: a randomized trial. The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy. Paracervical anaesthesia in outpatient hysteroscopy: a randomised double-blind placebo-controlled trial. Oral dexketoprofen for pain treatment during diagnostic hysteroscopy in postmenopausal women. A randomised double-blind placebo-controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy. Randomised placebo controlled trial of mefenamic acid for premedication at outpatient hysteroscopy: a pilot study. Lidocaine spray and outpatient hysteroscopy: randomized placebo-controlled trial. Randomized placebo controlled trial to assess the role of intracervical lignocaine in outpatient hysteroscopy.
To compare the amount of pain during and after hysteroscopy using local intracervical and combined local and paracervical anesthesia.
                Prospective randomized trial (Canadian Task Force classification I).
                University teaching hospital.
                Eighty-four women who underwent outpatient hysteroscopy for evaluation of the uterine cavity at McGill University Health Center.
                Randomization to local intracervical or combined local and paracervical anesthesia.
                Amount of pain experienced during the procedure and at 10, 30, and 60 minutes after the procedure was measured using a visual analog scale ranging from zero to 10 (zero = no pain; 10 = excruciating pain). The mean age of the patients in the local anesthesia group was 36.1 +/- 0.7 years and in the combined local and paracervical anesthesia group was 35.2 +/- 0.7 years. Patients experienced significantly more pain during than after the procedure. The mean pain scores in the local anesthesia group were significantly higher than in the combined anesthesia group during the procedure (3.2 +/- 0.3 vs 2.1 +/- 0.2; p <.01; 95% CI 0-2), 10 minutes after the procedure (1.9 +/- 0.2 vs 1.5 +/- 0.3; p = .03; 95% CI 0-1), and 30 minutes after the procedure (1.7 +/- 0.2 vs 1.0 +/- 0.2; p = .02; 95% CI 0-1). However, there was no significant difference in pain scores at 60 minutes after the procedure between the local anesthesia and combined anesthesia groups (0.9 +/- 0.2 and 0.7 +/- 0.1, respectively).
                Outpatient hysteroscopy with local or combined local and paracervical anesthesia was well tolerated by patients. However, combined anesthesia was associated with less pain during and at 10 and 30 minutes after the procedure. Most patients considered the pain as mild. To assess the efficacy of sublingual buprenorphine in the relief of pain associated with office hysteroscopy.
                Prospective, randomized study (Canadian Task Force classification I).
                Tertiary medical center.
                One hundred sixty-four women referred for office hysteroscopy from September 2003 through March 2004.
                Before hysteroscopy, 80 women received a tablet of buprenorphine (group A), and 84 women received a placebo (group B). Their pain sensations were evaluated on a 10-cm visual analog scale, and they were asked about the adverse reactions and level of satisfaction on the following day.
                The pain score in group A was 3.3 +/- 1.1, which was similar to 3.2 +/- 1.3 in group B. The pain scores in subgroups of women also were similar within the same group and between the two groups. Thirty-one women (38.8%) in group A reported adverse reactions, including nausea, vomiting, and drowsiness, while none in group B reported any adverse reactions.
                Office hysteroscopy with a 3.1-mm flexible hysteroscope is a well-tolerated procedure. Sublingual buprenorphine is not helpful in relieving the pain associated with hysteroscopy but is associated with significant adverse reactions. nan nan To evaluate the amount of pain during office hysteroscopy and endometrial biopsy with and without intrauterine anesthesia.
                Prospective randomized study (Canadian Task Force classification I).
                Academic teaching center.
                A total of 82 women underwent outpatient hysteroscopy for evaluation of their uterine cavity.
                Randomization to local cervical or combined cervical and intrauterine anesthesia.
                Amount of pain experienced during the procedure; 10, 30, and 60 minutes after the procedure; and during endometrial biopsy. We used a visual analog scale ranging from 0 to 10 (0: no pain, 10: excruciating pain). Of 82 patients, 4 patients were excluded, 36 patients underwent hysteroscopy using local cervical anesthesia, and 42 others with combined cervical and intrauterine anesthesia. The mean age of the patients in the local group was 37.4 +/- 0.8 years and in the combined group was 38.3 +/- 0.7 years. In both groups, patients experienced significantly more pain during and 10 minutes after the procedure than 30 and 60 minutes after. No significant differences occurred in the pain scores during the hysteroscopy, and 10, 30, and 60 minutes after between the 2 anesthesia groups. The pain score in the local group during endometrial biopsy was significantly higher than during (p <.05), 10 minutes after (p <.001), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure, respectively. In the combined group, compared with the pain score during endometrial biopsy, the scores during the hysteroscopy (p <.05), 10 minutes after (p <.01), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure were also less, respectively.
                Intrauterine anesthesia with medicated saline as a distending medium is ineffective. Endometrial biopsy is associated with more pain than hysteroscopy. OBJECTIVE: To assess the efficacy of lignocaine gel in reducing the overall pain and pain of individual steps during outpatient hysteroscopy in comparison with placebo (no anesthesia). DESIGN: A prospective, randomized, double-blind, placebo-controlled trial. SETTING: Outpatient hysteroscopy clinic in a regional hospital in Hong Kong. PATIENT(s): A total of 500 Chinese patients undergoing outpatient hysteroscopy. INTERVENTION(s): Application of lignocaine gel to the cervix during outpatient hysteroscopy. MAIN OUTCOME MEASURE(s): Mean pain score using present pain intensity, overall pain score measured by total area under the curve, and the pain score of individual steps in the procedure in patients receiving lignocaine gel were compared with those of patients having no anesthesia. The failure rate and poor-view rate in both groups were also compared. RESULT(s): There were no statistically significant differences in mean pain score, overall pain score, and pain score of individual steps between the lignocaine group and controls. The failure rate and poor-view rate also showed no statistically significant differences. CONCLUSION(s): Outpatient hysteroscopy without anesthesia is acceptable to most Chinese women, and the local application of lignocaine gel is not effective in reducing pain. A prospective, randomized study was undertaken to objectively compare pain tolerance of 2 methods of local analgesia for outpatient hysteroscopy. Patients in group 1 received a paracervical block using 20 ml of 1% lignocaine. Patients in group 2 received a uterosacral block using 2 ml of 2% lignocaine. There was no statistical difference between the 2 groups (p = < 0.65) in efficacy of pain relief. The method used for patients in group 2 reduces time and costs for outpatient hysteroscopy. One hundred seventy-seven women aged 41 +/- 8 (mean +/- SD) years, referred for evaluation of excessive uterine bleeding, were enrolled in an open-label randomized trial to evaluate the efficacy of local anesthesia before hysteroscopy in an outpatient population. The patients underwent hysteroscopy and endometrial biopsy with paracervical block by 10 mL of 1% mepivacaine hydrochloride solution (n = 87) or no local anesthesia (n = 90) and assessed lower abdominal and pelvic pain according to a 10-point linear analog scale. The mean +/- SD pain score was 4.5 +/- 2.0 at hysteroscopy and 5.2 +/- 2.1 at endometrial biopsy in the 87 subjects given a paracervical block versus 4.9 +/- 2.2 and 5.7 +/- 2.4 in the 90 women not given local anesthesia, without statistically significant differences. Paracervical anesthesia for routine outpatient hysteroscopy in premenopausal women may be superfluous. To evaluate the efficiency of paracervical anesthesia in reducing pain and the incidence of vasovagal reactions during diagnostic hysteroscopy with endometrial biopsy in postmenopausal women.
                A randomized, placebo-controlled, double-blind study. Seventy-two postmenopausal women underwent diagnostic hysteroscopy and endometrial biopsy. Hysteroscopies were performed by using a lens-based endoscope with a diameter of < 4 mm and endometrial biopsies by using a 3-mm Novak's curette. Ten milliliters of 1.5 mepivacaine or saline solution was injected at the junction of the cervix and vagina (at the 4 and 8 o'clock positions) by means of an appropriate needle before performing the intrauterine procedures. Referred pain was evaluated by means of a visual analogue scale; continuous monitoring of heart rate and blood pressure was also performed.
                Paracervical anesthesia significantly reduced pain at hysteroscopy and biopsy. The incidence of vasovagal reactions was also significantly lower in the anesthetized group.
                Paracervical anesthesia is effective for hysteroscopy and endometrial biopsy in postmenopausal women and may be indicated particularly for patients with cervical stenosis, for very anxious subjects and in all situations where pain stimulation could trigger threatening side effects due to systemic pathologies. The study was designed to compare local anaesthesia and conscious sedation for outpatient bipolar operative hysteroscopy in terms of pain control and patients' satisfaction.
                A prospective multicentre randomized study was carried out in university hospitals and in a private endoscopy unit. A total of 166 women with surgically treatable lesions associated with infertility or abnormal uterine bleeding was considered eligible for the study. Patients were randomized, using a computer-generated randomization list, into two groups. Group A (82 patients) underwent operative hysteroscopy with local anaesthesia. Group B (84 patients) received conscious sedation. Operative hysteroscopy was performed with a bipolar electrosurgical device to cut, vaporize and coagulate. Main outcome measures were pain control during the procedure, the post-operative pain score at 15 and 60 min, and at 24 h after the procedure, and patients' satisfaction rate.
                All procedures were completed within 35 min, the amount of saline used varied from 400-1200 ml. There were no significant differences between local anaesthesia and conscious sedation in terms of pain control during the procedure and in postoperative pain at different intervals. Satisfaction rate was similar in the two groups.
                Both local anaesthesia and conscious sedation can be used for operative hysteroscopy using a bipolar electrosurgical system without significant differences in terms of pain control and patients' satisfaction. Office hysteroscopy with endometrial biopsy is usually the first investigation for abnormal uterine bleeding and other uterine diseases.
                To evaluate the effect of oral drotaverine with mefenamic acid on pain perception during hysteroscopy and endometrial biopsy and to compare it with that of paracervical block using 1% lignocaine and with that of intravenous sedation using diazepam with pentazocine.
                Outpatient gynecological department and open randomized trial.
                One hundred twenty women undergoing hysteroscopy and endometrial biopsy were randomized into 3 groups. Group I received tablet containing drotaverine hydrochloride (80 mg)+mefenamic acid (250 mg), group II received lignocaine paracervically and group III received intravenous diazepam. The intensity of pain during the procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed.
                Statistical analysis was performed using Kruskal-Wallis test, with the Bonferroni correction, the t test, and the chi2 test.
                Groups were similar in age, parity, vaginal birth or relevant medical history. A statistically significant difference in pain scores was noted among the 3 groups during the procedure (group I, 4.13+/-1.28; group II, 5.93+/-1.26; group III, 5.58+/-1.51), (P<0.001); as well as 30 minutes later (group I, 1.78+/-0.89; group II, 2.53+/-0.81; group III, 2.23+/-0.94), (P<0.001) and 60 minutes later (group I, 1.2+/-0.46; group II, 1.98+/-0.83; group III, 1.68+/-0.75), (P<0.001). VAS at different time intervals among the groups was also statistically significant. No adverse effects were observed.
                Oral drotaverine with mefenamic acid is effective in women undergoing hysteroscopy and endometrial biopsy. To evaluate the efficacy and safety of topical anaesthesia in reducing pain and incidence of vasovagal reactions during diagnostic hysteroscopy with endometrial biopsy in postmenopausal women.
                Randomised placebo-controlled double-blind study.
                University hospital.
                Eighty postmenopausal women undergoing diagnostic hysteroscopy and endometrial biopsy.
                Two millilitres of 2% mepivacaine or saline solution were injected transcervically into the uterine cavity before performing the procedures.
                Evaluation of pain reduction on a visual analogue scale and continuous monitoring of heart rate and blood pressure.
                The use of the anaesthetic significantly reduced the pain experienced at hysteroscopy and endometrial biopsy. The occurrence of vasovagal reactions was significantly lower in the anaesthetised group.
                Topical anaesthesia attenuated pain and effectively prevented the occurrence of vasovagal reactions during hysteroscopy and endometrial biopsy in postmenopausal women. Three methods of diagnostic hysteroscopy have been tested for both women's compliance and feasibility of procedures in postmenopause.
                Three hundred and sixty-two postmenopausal women were enrolled in a three-arm study: 5 mm diagnostic sheath (Group 1, 119 women), 5 mm sheath with paracervical block (Group 2, 121 women), and 3.5 mm sheath (Group 3, 121 women). CO2 was the distention medium. Both feasibility of hysteroscopy (procedures failed due to stenosis or incomplete distention of cavity) and discomfort of women have been recorded. Pain perception has been measured on a visual numerical rating scale. Statistical analysis was performed by t-test for unpaired samples and chi-square test.
                Paracervical block was per se painful in 18.2% and bleeding from injection site occurred in 38.8%. Hysteroscopy failure due to stenosis occurred in 9%, 10% and 0.4% of the three groups respectively (p<0.01). Intolerable pain was reported by 17% of women in Group 1, 6% in Group 2 (p<0.05) and in none of Group 3 (p<0.01). Pain score improved from Group 1 to Group 3 (p<0.01). Hysteroscopy was incomplete because of gas leakage in 1.7% of both Group 1 and 2 and in 13.2% of Group 3 (p<0.01).
                Pain perception in postmenopausal women was reduced when paracervical block was used, but discomfort was even less with the narrow sheath hysteroscope. The narrow sheath will expose to a high percentage of inconclusive procedures but it can be overcome by changing to the large sheath hysteroscope without affecting patient pain perception. To show that intrauterine anesthesia is a reliable method for reducing pain associated with endocavitary procedures.
                A prospective, randomized, double-blind study.
                The Department of Obstetrics and Gynecology, Tor Vergata University of Rome, Rome, Italy.
                Forty-five patients undergoing diagnostic hysteroscopy (n = 27) or hysteroscopy and endometrial biopsy (n = 18).
                Five milliliters of 2% mepivacaine or saline solution were injected transcervically into the uterine cavity before performing the procedures.
                Evaluation of pain reduction on a visual analogue scale.
                Pain expectation and pain reported were reduced during and after the procedures.
                Topical anesthesia effectively reduces pain during hysteroscopy and endometrial biopsy. To evaluate the efficacy and safety of paracervical anaesthesia in reducing pain during outpatient hysteroscopy and endometrial biopsy.
                Prospective, randomised, placebo-controlled, double-blind study.
                One hundred women undergoing outpatient hysteroscopy and endometrial biopsy for abnormal uterine bleeding.
                Paracervical block using 10 mL of either 2% lignocaine or normal saline before the procedure.
                Evaluation of pain at different stages of hysteroscopy using a visual analogue scale together with blood pressure and heart rate monitoring.
                Compared with placebo, paracervical anaesthesia significantly reduced the pain only at the time of insertion of the hysteroscope, but not at the subsequent stages of the procedure. However, paracervical injection of lignocaine resulted in a higher incidence of bradycardia and hypotension.
                Paracervical anaesthesia not only fails to reduce pain during outpatient hysteroscopy and endometrial biopsy, but also carries a risk of inducing bradycardia and hypotension, which is probably a result of inadvertent intravascular injection. To assess the efficacy of dexketoprofen (DEX) in reducing pain at different stages of the hysteroscopic procedure in comparison with local anaesthesia in menopausal women.
                Menopausal patients affected by uterine bleeding submitted to diagnostic hysteroscopy, were randomised to receive either 25 mg DEX tablet (n = 148) or intracervical injection of 5 ml mepivacaine 2% (n = 150). Pain suffered during the procedure itself and 30, 60, 120 min after, was scored on the 11 point Visual Analogic Scale, recorded and analysed.
                No statistical difference were noted during the procedure itself in both groups of treatment. Patients treated with DEX has significantly less postoperative pain.
                DEX is not superior to mepivacaine in reducing the discomfort of the procedure but does significantly reduce postoperative pain.
                Copyright 2002 Elsevier Science Ireland Ltd. To assess whether transcervical intrauterine instillation of local anaesthetic agent reduces pain during diagnostic outpatient hysteroscopy and endometrial biopsy.
                Prospective, randomised, double blind, placebo-controlled trial.
                Outpatient hysteroscopy clinic in a university teaching hospital.
                Ninety women undergoing outpatient diagnostic hysteroscopy with or without endometrial biopsy.
                Transcervical intrauterine instillation of 5 mL of 2% lignocaine into the uterine cavity before performing the procedure.
                Evaluation of pain at different stages of the procedure using a visual analogue scale and changes in blood pressure and heart rate.
                The use of local anaesthetic did not alleviate pain experienced during hysteroscopy and endometrial biopsy. It did not prevent the occurrence of vaso-vagal reactions; however the incidence of these was low.
                Transcervical instillation of local anaesthesia neither reduced pain nor prevented vaso-vagal reaction during hysteroscopy and endometrial biopsy. An increasing number of diagnostic hysteroscopies are being performed in an outpatient setting. Most women tolerate the examination well, but the single commonest reason for failure is pain. We assessed the efficacy of a nonsteroidal, anti-inflammatory analgesic as premedication before hysteroscopy in a double-blind, placebo controlled trial. Our results showed that 500 mg mefenamic acid given one hour before hysteroscopy had no significant benefit in the discomfort experienced during the procedure but did significantly reduce pain after hysteroscopy. A larger dose or a longer interval between premedication and hysteroscopy may possibly be associated with greater benefits. To assess the efficacy of lidocaine spray during outpatient hysteroscopy for reducing procedure-related pain and to identify risk factors for discomfort.
                One hundred twenty-one women were assigned randomly to have application of lidocaine spray or placebo to the uterine cervix during outpatient hysteroscopy. The main outcome measure was pain during hysteroscopy, assessed on a visual analog scale.
                There was no statistically significant difference between study and control groups in mean age, rate of nulliparity, postmenopausal state, need for cervical dilation, or percentage of women who used hormone replacement therapy. Indications for diagnostic hysteroscopy were similar between groups. Women in the lidocaine group had statistically significantly less pain during the procedure than women in the placebo group (2.2 +/- 1.9 and 3.7 +/- 2.5, respectively; P <.001). Women with abnormal uterine findings (submucous myoma, endometrial polyps, or intrauterine adhesions) had significantly higher pain scores than women with normal cavities (2.2 +/- 1.9 and 3.2 +/- 2.4, respectively; P <.002). Aerosol anesthesia and normal uterine findings were independently associated with less pain. No procedure had to be abandoned because of excessive pain or complications, and no women required hospitalization.
                Women treated with lidocaine spray had significantly less pain. Uterine cavity abnormality might be associated with a higher degree of pain during hysteroscopy. nan
There was a significant reduction in the mean pain score with the use of analgesia during and within 30 minutes after outpatient hysteroscopy.