Effect of applying cold gel pack on reduction of postoperative pain in cesarean section, low midline skin incision: A randomized controlled trial.

AIM: The present study aims to investigate the efficacy of cryotherapy in pain reduction following low midline cesarean section. METHODS: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Thammasat University Hospital, Thailand from December 2019 to February 2020. Participants were term pregnant women who were indicated for low midline cesarean section. The control group received standard postoperative care while cold pack was applied to the intervention group for 6 h after the operation. The primary outcome was the postoperative visual analog scale (VAS) score in both the control and intervention groups. The secondary outcomes consisted of the amount of intravenous pain reliever each participant required and the length of hospital stay. RESULTS: All 100 pregnant women were recruited into the study. They were equally allocated into intervention or control groups. Both groups underwent cesarean section under spinal anesthesia. The demographic characteristics of both groups were comparable. VAS of intervention and control group were 3.2 ± 2.4 versus 5.3 ± 2.2, 3.0 ± 2.4 versus 5.6 ± 2.0, 2.0 ± 2.3 versus 5.3 ± 2.2, and 1.1 ± 1.7 versus 4.8 ± 2.4 at 6, 8, 12, and 24 h postoperatively (p-value <0.05), respectively. Moreover, the intervention group showed a statistically significantly lower number of participants who needed intravenous meperidine or tramadol (14% vs. 24%, p-value <0.05) and lower intravenous meperidine or tramadol usage than in control group (13.2 ± 0.9 vs. 19.9 ± 4.0 mg, p-value <0.05). CONCLUSIONS: Cryotherapy could reduce postoperative pain from 6 h to within 24 h of the postoperative period, as well as lower overall opioid requirement.

Cold therapy for pain relief during and after amniocentesis procedure: A randomized controlled trial.

AIM: To compare effects of cold therapy on patient pain score during and after amniocentesis procedure. METHODS: We performed a prospective randomized-controlled study comparing the anticipated pain, perceived pain during the procedure, and pain after 15 and 30 min of amniocentesis between pregnant women receiving cold therapy before (group 1), after (group 2), and both before and after amniocentesis (group 3) with a control group (group 4). Pain was measured using a visual analog scale (VAS) score. RESULTS: A total of 480 participants were recruited and randomly assigned into four groups of 120 each. Anticipated pain scores in all groups were not statistically different. When compared with group 4, groups 1 and 3 experienced significant pain reduction during amniocentesis, while VAS scores at 15 and 30 min after amniocentesis in groups 1-3 were significantly lower as compared to group 4. CONCLUSION: Cold therapy both before and after amniocentesis procedure is most effective in pain reduction. It encourages the pregnant woman's cooperation during the procedure and provides a good amniocentesis experience. Application of cold compression is also beneficial in other aspects as it is simple, safe, convenient, and yet reusable and economically efficient for routine use in all pregnant women undergoing amniocentesis.

Comparative Study of Postoperative Pain between Maylard Incision and Pfannenstiel Incision in Gynecologic Surgery: A Randomized Controlled Trial.

Background: Postoperative pain has many adverse effects for the patients with laparotomy operation. There are few studies that compare between Maylard and Pfannenstiel incision in term of pain and wound complication after operation. Objective: To compare the postoperative pain and wound complications between the muscle-cutting Maylard incision and the Pfannenstiel incision in women who needed benign gynecologic surgery. Material and Method: This randomized controlled trial study compared two laparotomy techniques, Maylard and Pfannenstiel method. Ninety cases of benign gynecologic conditions were recruited and randomly assigned to receive either Maylard or Pfannenstiel incision from August 2014 to October2015 at Thammasat University Hospital, Thailand. Visual analogue scale (VAS) was applied to measure postoperative pain. Baseline characteristics of the study groups and postoperative outcomes were analyzed. Results: From the planned 90 recruited cases, there were 81 cases for complete analysis, 41 in Maylard and 40 in Pfannenstiel group. There were no difference in age, body mass index, education level, previous abdominal surgery and type of operation between Maylard and Pfannenstiel group. Duration of operation, type of anesthesia and dosage of analgesic drug were not statistically significant between both groups. Length of surgical wound was longer in Maylard than in Pfannenstiel group (17.27±0.6 vs. 14.13±0.8 cm, p = 0.04). Postoperative pain score (VAS) at 3, 6, 12, 24 and 48 hours were not statistically different between two groups. Pain score at 72 hours and 7th day in Maylard group showed significantly less than in Pfannenstiel group (0.51±0.5 vs. 1.10±1.0 p = 0.04, 0.12±0.3 vs. 0.23±0.4, p = 0.01, respectively). The numbers of participants with moderate to severe pain (VAS >4) in Maylard group were less than in Pfannenstiel group at 3, 6, 12 and 24 hours but after that there was no statistically difference. There were no postoperative wound complications such as disruption, infection or hematoma in all participants in this study. Conclusion: Postoperative pain up to 48 hours in both Maylard and Pfannenstiel group showed similar VAS but after 48 hours; the Maylard group showed less pain. Even though the surgical wound length in Maylard group was longer than Pfannenstiel group, numbers of cases with VAS >4 within 24 hours in Maylard were less than in Pfannenstiel group. Postoperative pain up to 48 hours in both Maylard and Pfannenstiel group showed similar VAS but after 48 hours; the Maylard group showed less pain. Even though the surgical wound length in Maylard group was longer than Pfannenstiel group, numbers of cases with VAS >4 within 24 hours in Maylard were less than in Pfannenstiel group.

Nomogram of Intracranial Translucency in the First Trimester Ultrasound of Pregnant Women at Thammasat University Hospital.

Objective: The aim of the study was to determine normative values of intracranial translucency (IT) by ultrasonography in singleton pregnant women patient at Thammasat University Hospital during the first trimester. Material and Method: The first trimester singleton pregnant women (11-13 weeks) underwent routine ultrasonography screening. The gestational age was calculated by measuring the length of the embryo or fetus from the top of its head to bottom of the buttocks (crown-rump length; CRL) and IT of the brain region in the mid-sagittal planefetal face position. Repeated ultrasonography was performed in the second trimester period as well as after birth infant check-up for disability. Results: One hundred and ninety one singleton pregnant women were examined by an ultrasonography to measure CRL, GA and IT. The average age was 29.71±5.09 years (16-39 years). All participants were healthy without a history of anomaly in previous pregnancies. Half of cases were nulliparity. Participants were followed until birth. There was no open neural tube defect baby in this study. Median GA, CRL and IT in this study were 12.6+0.7 weeks, 64.0±10.2 (40.0-80.9) and 1.3±0.3 (0.5-2.5) mm, respectively. IT measurement value increased in correlation with increasing CRL and advancing GA (p<0.05). Conclusion: IT values increased significantly with CRL and GA increasing.

Postoperative Pain Relief in Major Gynaecological Surgery by Perioperative Parecoxib Administration: Thammasat University Hospital Study.

OBJECTIVE: To study postoperative pain relief in major gynaecological surgery by perioperative parecoxib administration in Thammasat University Hospital. MATERIAL AND METHOD: This double-blind randomized controlled clinical trial was conducted in Thammasat University Hospital, Pathumthani, Thailand from October 2013 to May 2014. One hundred and twenty patients who underwent elective gynaecological surgery were randomized assigned to study and control groups. Study group (n = 60) received 40 mg parecoxib and control group (n = 60) received placebo at 1 hour before surgery. The postoperative visual analog scale (VAS) at 3, 6, 12 and 24 hours, frequency of meperidine consumption in 24 hours and side effects of parecoxib were recorded. RESULTS: VAS of study group after operation at 3, 6, 12 and 24 hours was significantly lower than control group. Meperidine consumption in placebo group was significantly higher than study group (27.50 ± 19.36 and 48.75 ± 28.15 mg, respectively; p < 0.001). There was no side effect from parecoxib in this study. CONCLUSION: Intravenous postoperativeparecoxib injection could relief pain and reduced meperidine consumption. Parecoxib could be safely used in gynaecological surgery for postoperative pain relief

Incidental Finding of Metastatic Cutaneous Malignant Melanoma at Uterine Leiomyoma, A Thai University Hospital Experience: A Case Report.

BACKGROUND: Metastatic malignant melanomas to the uterus are extremely rare; to our knowledge, no more than 13 cases have been reported to date. CASE REPORT: A 44-years-old multigravida woman presented with a black and irregular surface mass at medial aspect of left thigh. There was also an enlarged left groin node. Wide excision with lymph node dissection revealed malignant melanoma. Further examination found a huge pelvic mass with left deep vein thrombosis consequent by pressure effect. Chest and complete abdominal computed tomography revealed an enlarged, fibroid uterus with pressure effect at left common iliac vein. A total abdominal hysterectomy and bilateral adnexectomy were performed. Intra-operative finding was scattered hyperpigment spots at surface of the uterus and its tumor Histopathological report showed metastatic malignant melanoma involving myometrium and uterine serosa. Diagnosis of stage IV malignant melanoma (uterine metastasis) was achieved. The patient was counseled about her diagnosis, stage, prognosis and further treatment. CONCLUSION: Uterine metastatic malignant melanoma was a rare condition. This report represents the first case of a cutaneous malignant melanoma involving a uterine leiomyoma in Thailand.

Twin Reversed Arterial Perfusion (TRAP) Sequence: A Case Report and Review of Treatment.

A cardiac twin or twin reversed arterial perfusion (TRAP) sequence is a rare unique complication of monozygotic multiple pregnancy. In this disorder, there is a normally formed donor (the pump twin) who has features of congestive heart failure (CHF) as well as a recipient (the acardiac twin) who lacks a well-defined a heart structure. Also evident are other structures, namely the TRAP sequencefrom pump to acardiacfetus via single artery-to-artery and vein-to-vein anastomoses directly between the two cords or indirectly on the chorionic plate. Overall, the perinatal mortality rate for the pump twin is 35-55%. Prenatal diagnosis and prognosis factors can be examined through ultrasound. The optimal management of a cardiac twin pregnancies is controversial. The expected treatment of acardiac anomaly presently relies on maximizing the chance ofterm delivery and preventing CHF in the healthy pump twin or interrupting vascularization between the two twins. This article reported the experience of acardiac twin management in Thammasat University Hospital and reviewed the current knowledge ofthe condition, prenatal diagnosis, prognosis factor and management options focusing on conservative management compared to invasive treatment.

The effectiveness of sublingual or oral administration of misoprostol for cervical ripening before manual vacuum aspiration in first trimester termination of pregnancy: randomized controlled trial.

OBJECTIVE: To compare the effectiveness of misoprostol sublingual and oral routes before manual vacuum aspiration (MVA) in first trimester termination of pregnancy. MATERIAL AND METHOD: A double-blinded randomized controlled trial was conducted infirst trimester termination ofpregnancy cases. Eighty cases were recruited and divided into sublingual and oral groups. Both groups were randomized to receive 400 microg misoprostol two hours prior to MVA. Main outcomes were cervical dilatation, operative time, complications, side effects, pain scores, and patient satisfactions. RESULTS: Sublingual group had significantly more cervical dilatation and shorter operative time than oral group (7.3 +/- 1.5 vs. 5.9 +/- 1.4 mm, p<0.001 and 5.2 +/- 3.3 vs. 7.3 +/- 4.6 min, p = 0.02, respectively). However there were similar side effects, pain scores, and patient satisfactions in two groups. The present study had no uterine perforation, cervical tear hemorrhage, or re-evacuation. CONCLUSION: Sublingual misoprostol route was more effective for cervical priming prior to MVA in first trimester therapeutic abortion than oral route.

Maylard incision in gynecologic surgery: 4-year experience in Thammasat University Hospital.

OBJECTIVE: To present the results of Maylard incisionfor gynecologic surgery in Thammasat University Hospital during the past four years. MATERIAL AND METHOD: A retrospective study of gynecologic surgery performed via the Maylard muscle cutting incision compare to Pfannenstiel muscle splitting and midline incision. Data came from subjects who underwent gynecologic surgey at Thammasat University Hospital, Pathumthani, Thailand friom January 2010 to December 2013. RESULTS: In the period of 4 years, there were 283 cases of elective surgery that performed via Maylard, Pfannenstiel and midline incision by the single experience gynecologic surgeon team. One hundred and six cases were performed via Maylard incision technique. The remaining 59 and 118 cases were performed via Pfannenstiel and midline incision technique, respectively. Two-thirds and one-thirds of cases underwent hysterectomy and conservative surgery, respectively. Benign conditions were the major indicationfor surgery at the percentage of 83.4. Operative results were not significantly different from well-known midline and Pfannenstiel incision in terms of blood loss, time to first meal and postoperative pain. Operative time in Maylard incision was longer than in Pfannenstiel incision. Length of stay in Maylard incision was longer than Pfannenstiel but shorter than midline incision. Overall complications (eoperation, bowel injuries, urinary bladder injuries and blood transfusion rate) were not significantly different. CONCLUSION: Maylard incision provides similar operative results with midline and Pfannenstiel technique. Even though it takes more time for abdominal entry but it gives more operative exposure than Pfannenstiel incision. In the woman with previous low transverse scar and gynaecologic surgery is needed, Maylard incision could be an optional technique that provides cosmetic and successfud results. Hand on training for Maylard incision from their mentors should be encouraged to more practice.

Prenatal diagnosis of placenta accreta by colour Doppler ultrasonography: 5-year review.

OBJECTIVE: To determine the accuracy of colour Doppler ultrasonography to diagnose placenta accreta. MATERIAL AND METHOD: The authors reviewed cases of placenta accreta between January, 2008 and December, 2012. Ultrasonographic images consistent with signs ofplacenta accreta (numerous vascular lacunae, loss ofsubplacentalsonolucent space, absent lower uterine segment between bladder-placenta, turbulent or complicated blood flow at the uteroplacental interface) were correlated with findings at the time of surgery and pathologic examination. RESULTS: Over 60 months, 12 cases (0.48/1,000 deliveries) with suspected placenta accreta by ultrasonography were studied. The median gestational age atfirst diagnosis was 24 weeks. All cases had at least one previous cesarean delivery. At surgery, all cases had an adherent placenta requiring hysterectomy (five accreta, three increta, andfourpercreta). Four cases (33%) had accidental tear of urinary bladder Nine cases (75%) required blood transfusions. CONCLUSION: Colour Doppler ultrasonography appears useful in antenatal diagnosis ofplacenta accreta.

Spontaneous uterine rupture at non-cesarean section scar site with placenta percreta in the second trimester: a case report.

BACKGROUND: Uterine rupture was a common occurrence at previously cesarean-sectioned scar Early sign ofuterine rupture was a severe fetal bradycardia. CASE REPORT: A 30-year-old, 3 gravida, 1 para woman was presented with an acute abdominal pain and hypovolemic shock. Her gestational age was estimated at 18 weeks by emergency pelvic ultrasound. She had a lower segment scar from a previous caesarean section. Initially, alive intrauterinepregnancy with massive hemoperitoneum was a provisional diagnosis. During exploratory laparotomy, a ruptured of the right uterine fundus was found with placenta percreta. Hysterectomy was performed. Fetal weight was 450 grams, APGAR score 0, 0 and the fetus could not survive. The patient was discharged on the 4th day after surgery in healthy condition. CONCLUSION: Uterine rupture is a catastrophic kituation. Severefetal bradycardia might be an early sign. This case demonstrates the importance ofclinical judgment based on clinical acumen.

Transvaginal color Doppler study of uterine artery: is there a role in chronic pelvic pain?

AIM: To determine the value of transvaginal color Doppler study of uterine artery and investigate the differences in blood flow of uterine artery among women with chronic pelvic pain (CPP). MATERIAL & METHODS: A total of 50 female patients were recruited. The study group consisted of 25 women with CPP of possible gynecological origin. Twenty-five women without CPP made a control group. All women were examined using transvaginal color Doppler ultrasonogram after negative finding of pelvic examination. The mean pulsality index (PI) and resistant index (RI) of the uterine arteries were recorded and compared. RESULTS: The mean ages were 36.6 ± 10.6 and 32.0 ± 6.7 years in the study group and control group, respectively. The duration of pain ranges from 6-48 months (mean, 14.8). The mean PI and RI values of the uterine arteries in patients with CPP were significantly lower than in the control group; PI = 2.12 ± 0.78, 2.76 ± 0.84 and RI = 0.79 ± 0.19, 0.89 ± 0.05, respectively (P < 0.05). CONCLUSIONS: Doppler flow indices demonstrated significant increase of uterine arteries vascularization in CPP women related to pelvic causes. Transvaginal ultrasound with noninvasive Doppler study could be a useful primary investigation for CPP women, especially when financial resource is an issue.

Second trimester uterine artery Doppler screening in prediction of adverse pregnancy outcome in high risk women.

OBJECTIVE: To assess the value of uterine artery colour Doppler waveform analysis in the prediction of adverse pregnancy outcome such as preeclampsia, fetal growth restriction in high risk pregnancy women. MATERIAL AND METHOD: Uterine artery Doppler screening was performed as part of mid trimester screening between 20 and 24 weeks gestation in high risk pregnancy women at Matermal Fetal Medicine unit, Thammasat University Hospital between June 1, 2008 and May 31, 2009. A pulsatility index (PI) was calculated from each uterine artery and the presence or absence of a notch was determined. A PI of > 1.58 or the presence of any diastolic notch were defined as abnormal. The main outcome measures were pre-eclampsia and small for gestational aged baby (birth weight < 10th centile). RESULTS: Doppler examination of the uterine arteries were performed in 330 singleton pregnancies. Twenty-seven (8.18%) women developed pre-eclampsia, 16 (4.84%) women had SGA babies. The sensitivity ofPI > 1.58 and diastolic notch for preeclampsia, SGA were 59.25% and 56.25%, respectively.The specificity of PI >1.58 and diastolic notch for these outcomes were 66.67% and 65.60% respectively. CONCLUSION: In high-risk women, mid trimester uterine artery Doppler waveform analysis can not use as screening method in women at higher risk for the development of severe adverse outcome such as pre-eclampsia and SGA babies. However women with normal uterine artery Doppler results are unlikely to develop pre-eclampsia, fetal growth restriction (FGR) and therefore do not necessarily need repeated Doppler ultrasound follow-up.

Effect of fetal gender on ductus venosus pulsatility index and diameter at gestational age 17-37 weeks.

OBJECTIVE: Recent findings have suggested that ductus venosus blood flow in the first trimester may be influenced by fetal gender. The aim of the present study was to investigate further the influence of fetal gender on ductus venosus (DV) pulsatility index (PI) and diameter at gestational age 17-37 weeks. MATERIAL AND METHOD: This was a cross-sectional study. Three measurements were made for each the DV PI and diameter in each fetus during fetal quiescence. Statistical Package for the Social Sciences 14.0 software was used to create nomograms for the DV PI and diameter against gestational age in each gender group. The DV PI and diameter were compared between fetal genders using independent Student's t-test. RESULTS: There was no statistically significant difference in the DV PI and diameter between fetal sexes. CONCLUSION: Fetal gender does not influence the DV PI and diameter at gestational age 17-37 weeks.

Prediction of perinatal outcomes in patient with pre-eclampsia: maternal hyperoxygenation test on fetal Doppler flow.

OBJECTIVE: Investigate if the maternal hyperoxygenation test in pregnancy with pre-eclampsia could be used for prediction of perinatal outcomes. MATERIAL AND METHOD: Fifty-four singleton pre-eclampsia pregnant women were enrolled in the present study. Positive hyperoxygenation test was defined as an increase of the middle cerebral artery (MCA) or the ductus venosus (DV) pulsatility index (PI), or a decrease of the uterine artery or the umbilical artery (UA) PI by at least 20%. Results of hyperoxygenation test were analyzed for the correlation with perinatal outcomes. RESULTS: Fetuses with positive hyperoxygenation test of the MCA had a birth weight less than the negative group significantly. Furthermore, there was a significantly higher rate ofsmall for gestational age (SGA) neonates and admission to the neonatal intensive care unit (NICU) in cases with positive test of the MCA. CONCLUSION: The present study shows the correlation of positive hyperoxygenation test of the MCA and low birth weight, SGA, and NICU admission.

Cryotherapy Reduced Postoperative Pain in Gynecologic Surgery: A Randomized Controlled Trial.

OBJECTIVE: To examine the effectiveness of cryotherapy for reducing postoperative pain in patients who underwent exploratory laparotomy for gynecologic surgery. MATERIALS AND METHODS: Patients who had indication for an exploratory laparotomy gynecologic procedure were selected by attending physicians to undergo abdominal surgery via low transverse skin incision. The participants were randomized into study and control groups with simple random sampling methods. Cold packs were applied at two hours after operation for 6 hours. The visual analog scale (VAS) score was recorded at two, 6, and 12 hours after operation. RESULT: One hundred cases were recruited and then divided into study and control groups equally. The mean age of both groups was 43 years. There was no difference in demographics data of both groups. Half of the participants in both groups underwent hysterectomies. At two hours after surgery, both groups had similar VAS scores. The study group had a lower VAS score at 6 and 12 hours after surgery than the control group with statistical difference. Morphine consumption within 24 hours after surgery in both the study and control groups was 2.8±3.4 and 3.0±4.4 mg, respectively, with no statistical difference. However the registration time of the first morphine requirement in the study group was statistically more prolonged than that of the control group. The lengths of hospital stay in both groups were similar. There was no complication reported in this study. CONCLUSION: Cryotherapy can reduce postoperative pain. In this presented study the patients who underwent gynecologic surgery had improved pain relief and prolonged time for the first dose of the analgesic drug.

Fetal ductus venosus pulsatility index and diameter during 20-30 weeks gestation.

OBJECTIVE: To present normal range of the pulsatility index and the smallest diameter in the ductus venosus in normal fetuses throughout gestation. MATERIAL AND METHOD: This was a prospectively cross-sectional study. Three measurements were made for the ductus venosus diameter and the pulsatility index in each fetus during fetal quiescence. Statistical Package for the Social Sciences 14.0 software was used to create nomograms for the ductus venosus pulsatility index and diameter against gestational age. Four hundred and sixty normal fetuses aged seventeenth to thirty-seventh weeks were evaluated. RESULTS: The median diameter of the ductus venosus was linear across gestation. CONCLUSION: The nomograms for the ductus venosus pulsatility index and diameter are presented. The size of the narrowest portion of the DV grows in a linear relationship through gestation.

Nomograms of the fetal heart between 16 and 39 weeks of gestation.

OBJECTIVE: To establish the normal fetal cardiac measurement from 16 to 39 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Four hundred and eighty normal singleton pregnant women were recruited into the present study. The sonographic measurements were obtained from axial scans at the level of the four-chamber view. RESULTS: The regression model for cardiac circumference (CC), thoracic circumference (TC), thickness of left ventricular wall during diastole (LVW), diameter of left ventricle during diastole (LVD) and systole (LVS) and thickness of interventricular septum during diastole (IVS) were best fit by allowing a polynomial for gestational age. The cardiothoracic ratio (CTR) and shortening fraction of left ventricle (SFLV) were not statistically different with advancing gestation. CONCLUSION: The normal values of fetal CC, TC, CTR, LVW, LVD, LVS, IVS and SFLV during gestation were established These data could serve as a standard to investigate cardiac change in pregnancies with fetuses at risk.

Efficacy of Intrauterine Lidocaine Instillation in Reducing Pain during Endometrial Biopsy by Novak.

Abnormal uterine bleeding in women aged 35 years or over is an important clinical sign of many gynecological conditions. The diagnoses of these conditions require the pathological report of the endometrial tissue. Outpatient-based endometrial biopsy is an excellent option compared to standard fractional uterine curettage or hysteroscopy with endometrial biopsy in providing a definite diagnosis for abnormal uterine bleeding as it is less painful and does not require high potency anesthesia. This study evaluates the effect of intrauterine lidocaine on the patient's pain score during endometrial biopsy by the Novak curette. We included patients aged 35 years or more who had abnormal uterine bleeding between December 2016 and March 2018. The study was conducted at Thammasat University Hospital, Pathum Thani, Thailand. 250 patients were randomly allocated to either receive intrauterine lidocaine (study group) or normal saline (control group). Assessment of pain severity was evaluated using a visual analogue scale (VAS) score at 6 time-points, namely, before performing the procedure, when grasping the cervix by the tenaculum, during the intrauterine instillation of lidocaine or normal saline, during the uterine curettage, and then 15 minutes and 2 hours after the procedure. This study showed that there was significant pain reduction in patients who received intrauterine instillation of lidocaine compared to placebo, during uterine curettage, as well as 15 minutes and 2 hours after procedure (p<0.0001). Patient satisfaction was not significantly different between the two groups, while physician satisfaction significantly improved in the lidocaine group. Serious complications were not found during this study. (This research project had been approved for registration at Thai Clinical Trials Registry. TCTR identification number is TCTR20161031003.).

The Efficacy of Lidocaine Spray in Pain Relief during Outpatient-Based Endometrial Sampling: A Randomized Placebo-Controlled Trial.

Abnormal vaginal bleeding is one of the most frequent problems found in gynecology. Endometrial histopathology is needed for definite diagnosis. It was obtained either from endometrial tissue sampling or from standard uterine curettage. Office endometrial tissue sampling is an easy and low morbid procedure. It is usually associated with pain and discomfort. Topical anesthetic agent is needed for pain relieving. This study was conducted in outpatient gynecology clinic, Thammasat University Hospital, Thailand. It was a double blind randomized controlled trial. A total of 140 participants were enrolled in study and control group. Each group consisted of 70 cases. Study group received topical spray of 10% lidocaine (40 mg) before endometrial aspiration. Topical spray of 0.9% normal saline was performed in control group. Novak curettage was an application for endometrial tissue obtaining in this study. Visual analog scale (10cm-VAS) was used for pain evaluation. Demographic character of both groups showed no statistical difference. The percentage of participants who had severe pain (VAS≥7) during tenaculum application and Novak curettage insertion and during procedure were 28.5% (20/70) versus 12.9% (9/70), 55.7% (39/70) versus 38.5% (27/70), and 78.5% (55/70) versus 60% (42/70) in control and study group, respectively. Both groups had no significant differences of postoperative pain at 15 minutes and 2 hours. This study indicates that topical lidocaine spray can relieve pain during endometrial tissue sampling.