Lidocaine spray and outpatient hysteroscopy: Randomized placebo-controlledtrial

Objective: To assess the efficacy of lidocaine spray during outpatient hyst eroscopy for reducing procedure-related pain and to identify risk factors f or discomfort. Methods: One hundred twenty-one women were assigned randomly to have applic ation of lidocaine spray or placebo to the uterine cervix during outpatient hysteroscopy. The main outcome measure was pain during hysteroscopy, asses sed on a visual analog scale. Results: There was no statistically significant difference between study an d control groups in mean age, rate of nulliparity, postmenopausal state, ne ed for cervical dilation, or percentage of women who used hormone replaceme nt therapy. Indications for diagnostic hysteroscopy were similar between gr oups. Women in the lidocaine group had statistically significantly less pai n 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 (su bmucous myoma, endometrial polyps, or intrauterine adhesions) had significa ntly 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 f indings were independently associated with less pain. No procedure had to b e abandoned because of excessive pain or complications, and no women requir ed hospitalization. Conclusion: Women treated with lidocaine spray had significantly less pain. Uterine cavity abnormality might be associated with a higher degree of pai n during hysteroscopy. (Obstet Gynecol 2000;96:661-4. (C) 2000 by The Ameri can College of Obstetricians and Gynecologists).