A prospective randomized double-blind placebo-controlled study of local anaesthetic injected through the hysteroscope for outpatient hysteroscopy and endometrial biopsy

Objective To determine whether the injection of local anaesthetic through the hysteroscope at outpatient hysteroscopy, with or without endometrial biopsy, will reduce abdominal pain and increase patient acceptability of the two procedures. Design Prospective randomized double-blind placebo-controlled study. Setting Outpatient hysteroscopy clinic, Royal Hospital for Women, Sydney, Australia. Subjects 100 women undergoing outpatient hysteroscopy with or without endometrial biopsy. Interventions Randomization into two groups: local anaesthetic (group 1) and placebo (group 2). Upon introduction of the hysteroscope into the cervical os, 5 ml of 2% plain lignocaine (group 1) or normal saline (group 2) was introduced via the channel in the hysteroscope. After 2 min, the hysteroscopy and endometrial biopsy (where indicated) were conducted in the usual manner. Main outcome measures The degree of pain experienced and the acceptability of the procedures were assessed using visual analogue scales. Results 99 women underwent hysteroscopy (49 in group 1 and 50 in group 2) with 92 also undergoing endometrial biopsy (45 in group 1 and 47 in group 2) Both groups were homogeneous for age, parity, menopausal status and subjective pain tolerance assessment. Group 1 found both the hysteroscopy and endometrial biopsy to be less painful and more acceptable, but these differences were not statistically significant. Four subgroups were analysed: nulliparous (group A), no past vaginal delivery (group B), postmenopausal (group C), and no previous dilatation and curettage (group D). Local anaesthetic reduced the 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). Conclusions Topical intra-uterine anaesthetic injected through the hysteroscope results in: (1) a trend towards a reduction in pain for both hysteroscopy and endometrial biopsy, and (2) a significant reduction in pain during endometrial biopsy in women who have not had a previous vaginal delivery, or dilatation and curettage, or are postmenopausal.