Use of Lidocaine During Vaginoscopic Hysteroscopy-Guided Biopsy Reduced Pain

DENVER — For women undergoing endometrial biopsy using vaginoscopic hysteroscopy, intrauterine lidocaine significantly decreased pain during and after the procedure, a double-blinded randomized trial showed.

Women randomized to lidocaine reported significantly less pain using a visual analogue scale (VAS) at hysteroscope insertion; during the biopsy; and at 10, 30, and 60 minutes after the procedure compared with those randomized to placebo (P

• VAS score during hysteroscope insertion: 2 vs 4
• VAS score during biopsy: 4 vs 5
• VAS score after 10 minutes: 2 vs 4
• VAS score after 30 minutes: 1 vs 3
• VAS score after 60 minutes: 0 vs 1

Additionally, lidocaine-treated patients had shorter ambulation times than those who received placebo (mean 9.2 vs 15.9 minutes, PPAmerican Society for Reproductive Medicine annual meeting.

Lidocaine-treated patients also reported higher satisfaction levels on a Likert scale, with 30.2% saying they were very satisfied and 55.6% saying they were satisfied compared with 1.59% and 25.4% of the placebo group (P=0.028). Of note, there were no complications or side effects associated with intrauterine lidocaine.

T P noted that vaginoscopic hysteroscopy makes it possible to see the uterine cavity directly; despite it being a popular procedure, there aren’t guidelines for anesthesia or analgesia.

Shannon Laughlin-Tommaso, MD, of the Mayo Clinic in Rochester, Minnesota, who wasn’t involved in the research, told MedPage Today that the study was well-designed and executed and explores a question top-of-mind for many patients.

“I think that there’s a lot of interest in getting pain control for any uterine procedures. And I think we are working towards a lot of analgesia and keeping the procedure still in the office, which is kind of the desire of most patients,” she said.

Laughlin-Tommaso also noted that there’s “tons on social media right now about pain during procedures.” Earlier this year, women went viral for recording their facial expressions while having intrauterine devices (IUDs) inserted.

“Anything that can reduce pain for the patients is really important,” she added.

This trial of 126 women scheduled for outpatient hysteroscopy-guided biopsy was conducted in Puducherry, India from January 2021 through December 2022. Women were block randomized to receive 5 mL of 2% lidocaine or 5 mL of saline solution for placebo. One person in the intervention group and four people in the placebo group required additional analgesia.

Women with pelvic inflammatory diseases, a hypersensitivity to lidocaine, previous cervical surgery less than 2 months before the procedure, use of cervical priming, pregnancy, or a history of cardiac disease, seizure disorder, bleeding disorder, or impaired liver function were excluded.

Participants’ baseline characteristics were similar between groups, including a mix of pre- and postmenopausal women. Mean age was 44 in the intervention group and 46 in the placebo group.

Of the 126 biopsies, 61.1% were for abnormal uterine bleeding, 27.8% were for postmenopausal bleeding, 5.6% were for infertility, and 5.6% were for bad obstetric history.

In a novel approach to vaginoscopic hysteroscopy, the researchers inserted a intrauterine insemination catheter to administer lidocaine or placebo; hysteroscopy was performed 5 minutes afterwards. Pain scoring was done at the time of hysteroscope insertion; during the guided biopsy; and 10, 30, and 60 minutes after the biopsy using the VAS score; blood pressure and pulse rate were measured at the same intervals.

T P pointed to the relatively small sample size as the primary study limitation, which also prevented the team from being able to conduct subgroup analyses.

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