Paracervical anaesthesia in outpatient hysteroscopy: a randomised double-blind placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of paracervical anaesthesia in reducing pain during outpatient hysteroscopy and endometrial biopsy. DESIGN: Prospective, randomised, placebo-controlled, double-blind study. POPULATION: One hundred women undergoing outpatient hysteroscopy and endometrial biopsy for abnormal uterine bleeding. INTERVENTIONS: Paracervical block using 10 mL of either 2% lignocaine or normal saline before the procedure. MAIN OUTCOME MEASURES: Evaluation of pain at different stages of hysteroscopy using a visual analogue scale together with blood pressure and heart rate monitoring. RESULTS: Compared with placebo, paracervical anaesthesia significantly reduced the pain only at the time of insertion of the hysteroscope, but not at the subsequent stages of the procedure. However, paracervical injection of lignocaine resulted in a higher incidence of bradycardia and hypotension. CONCLUSIONS: Paracervical anaesthesia not only fails to reduce pain during outpatient hysteroscopy and endometrial biopsy, but also carries a risk of inducing bradycardia and hypotension, which is probably a result of inadvertent intravascular injection.

Patient's acceptance of outpatient hysteroscopy.

There is a trend towards performing hysteroscopy and endometrial biopsy on an outpatient basis, as this alleviates the need for both an inpatient stay and a general anesthesia. Despite the wide acceptance by medical staff, there are few publications on how patients actually tolerate and accept these procedures. We performed a survey on 185 patients attending the outpatient hysteroscopy clinic at a teaching hospital to assess the degree of pain and their acceptance to those procedures using a visual analogue scale. All procedures were successfully performed under no anesthesia without complications. The mean age of the patients was 48 (range 24-78) and 9.4% were nulliparas. The mean pain experienced was 4.7 (SD 2.7) during hysteroscopy and 5.0 (SD 2.9) during endometrial biopsy. The overall preference scores for the procedure to be done under was 3.1 (SD 3.7). About 7% of patients expressed a preference for an overnight stay in hospital after the procedure, but the preference score was low (2.5, SD 3.6). The procedure was well accepted (8.3, SD 2.4) and highly recommended by the patients (8.4, SD 2.9). Outpatient hysteroscopy is well accepted and tolerated by patients.