A PROSPECTIVE RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED STUDY OF LOCAL-ANESTHETIC INJECTED THROUGH THE HYSTEROSCOPE FOR OUTPATIENT HYSTEROSCOPY AND ENDOMETRIAL BIOPSY

Objective To determine whether the injection of local anaesthetic thro ugh the hysteroscope at outpatient hysteroscopy, with or without endom etrial biopsy, will reduce abdominal pain and increase patient accepta bility of the two procedures. Design Prospective randomized double-bli nd placebo-controlled study. Setting Outpatient hysteroscopy clinic, R oyal Hospital for Women, Sydney, Australia. Subjects 100 women undergo ing outpatient hysteroscopy with or without endometrial biopsy. Interv entions Randomization into two groups: local anaesthetic (group 1) and placebo (group 2). Upon introduction of the hysteroscope into the cer vical os, 5 ml of 2% plain lignocaine (group 1) or normal saline (grou p 2) was introduced via the channel in the hysteroscope. After 2 min, the hysteroscopy and endometrial biopsy (where indicated) were conduct ed in the usual manner. Main outcome measures The degree of pain exper ienced and the acceptability of the procedures were assessed using vis ual analogue scales. Results 99 women underwent hysteroscopy (49 in gr oup 1 and 50 in group 2) with 92 also undergoing endometrial biopsy (4 5 in group 1 and 47 in group 2) Both groups were homogeneous for age, parity, menopausal status and subjective pain tolerance assessment. Gr oup 1 found both the hysteroscopy and endometrial biopsy to be less pa inful and more acceptable, but these differences were not statisticall y significant. Four subgroups were analysed: nulliparous (group A), no past vaginal delivery (group B), postmenopausal (group C), and no pre vious dilatation and curettage (group D). Local anaesthetic reduced th e pain at hysteroscopy in groups A, B and C and at endometrial biopsy in all groups, with groups B, C, and D at endometrial biopsy reaching statistical significance (P=0.05, 0.03, and 0.04, respectively). Concl usions Topical intra-uterine anaesthetic injected through the hysteros cope results in: (1) a trend towards a reduction in pain for both hyst eroscopy and endometrial biopsy, and (2) a significant reduction in pa in during endometrial biopsy in women who have not had a previous vagi nal delivery, or dilatation and curettage, or are postmenopausal.