ANESTHETIC BLOCKS FOR LOOP ELECTROSURGICAL EXCISION PROCEDURE

Background. Various types of anesthetic blocks have been used to prevent pain during ambulatory gynecologic surgery. The purpose of this study was to compare the pain and cramping perceived by patients during the loop electrosurgical excision procedure when intramucosal or distal paracervical blocks were used. Methods. Seventy-seven women consented to participate in the prospective clinical trial. All women were premedicated with a nonsteroidal anti-inflammatory drug. Immediately after the procedure, a trained interviewer, blinded to the type of anesthetic block, recorded the patient's perceptions of pain and cramping caused by the procedure. Age, parity, marital status, lesion severity, loop size used, number of specimens, amount of bleeding, method of hemostasis, and thermal artifact were included in the analysis. Results. On a Likert scale in which 0=no pain/cramping and 10=worst pain/cramping, the median pain score was 3 for the distal paracervical block and 4 for the intramucosal block. The median cramping scores were 3 and 2, respectively. Pain and cramping scores did not differ significantly between the two block cohorts. The demographic and procedural variables did not predict the perception of pain or cramping. Most (89.6%) of the study population experienced pain, whereas fewer (64.9%) experienced cramping. Subjects reported significantly less cramping than pain, irrespective of the anesthetic block used (chi 2=13.35, P=.0003). Conclusions. There is no difference in the perceptions of pain and cramping resulting from the loop electrosurgical excision procedure between patients receiving an intramucosal block and those receiving a distal paracervical block. There is minimal pain and cramping associated with the procedure.