Office Diagnostic and Operative Hysteroscopy Using Local Anesthesia Only: An Analysis of Patient Reported Pain and Other Procedural Outcomes

Study Objective: To evaluate the effectiveness of a multimodality local anesthetic protocol for office diagnostic and operative hysteroscopy. Design: Retrospective cohort study (Canadian Task Force classification II-3). Setting: Academic community based institution. Patients: Five hundred sixty-nine women undergoing 639 office-based diagnostic or operative hysteroscopic procedures. Interventions: Multimodality local anesthetic protocol addressing vagina, cervix, paracervical region, and endometrial cavity. Measurements and Main Results: Primary outcomes were numeric pain scores and rate of premature termination because of pain. Secondary outcomes included procedure pain and parity, delivery route, menopausal status, procedure type, and cost effect on procedure delivery. The overall mean (SD) pain score across 535 evaluable procedures was 3.7 (2.5). Patients undergoing operative hysteroscopy had a higher mean maximum pain score than did those who underwent diagnostic hysteroscopy only (4.1 vs 3.2; p < .001). There was no difference among women in different age groups; however, those with both cesarean section and vaginal delivery had scores higher than the mean (4.7 [0.4]; p < .001). The estimated cost savings was almost $2 million. Conclusion: Using a multimodality approach to local anesthesia, a broad spectrum of diagnostic and operative procedures can be performed successfully, comfortably, and inexpensively in the context of an office procedure room, without the need for procedural sedation. (C) 2014 AAGL. All rights reserved.