title: Lidocaine-prilocaine (EMLA) cream as analgesia for hysterosalpingography: a prospective, randomized, controlled, double blinded study.
abstract: BACKGROUND
  The aim of our study is to evaluate the efficacy of applying lidocaine 25 mg-prilocaine-25 mg/G cream (EMLA 5%) on the uterine cervix for pain relief when performing hysterosalpingography (HSG).
  
  
  METHODS
  Eighty-two patients undergoing HSG as part of infertility evaluation were randomized into groups receiving EMLA (42) or placebo cream (40) in a double-blinded prospective study from which four women were later excluded. The cream was applied to the uterine cervix by means of a cervical cup 30 min before the HSG. Pain perception related to the HSG procedure was scored by visual analogue scale (VAS) at five predefined steps: after speculum application, after cervical instrumentation of the tenaculum and cannula, at the end of uterine filling, at completion of tubal spillage, and immediately following instrument removal. In addition, the patients were asked to retrospectively rate the pain during the entire procedure in a telephone interview the following day.
  
  
  RESULTS
  Cervical instrumentation was found to be the most painful step of HSG (P < 0.001). When comparing the VAS pain scores, cervical instrumentation in the EMLA-treated patients was associated with significantly less pain than the control group: 3.3 +/- 2.9 versus 4.9 +/- 2.7, respectively (P = 0.02).
  
  
  CONCLUSIONS
  Topical application of EMLA 5% cream on the uterine cervix before performing HSG significantly reduced the pain during this procedure.
authors.affiliation: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem. liberg@013.net.il
authors.forename: G
authors.initials: G
authors.lastname: Liberty
authors.forename: M
authors.initials: M
authors.lastname: Gal
authors.forename: T
authors.initials: T
authors.lastname: Halevy-Shalem
authors.forename: R
authors.initials: R
authors.lastname: Michaelson-Cohen
authors.forename: N
authors.initials: N
authors.lastname: Galoyan
authors.forename: J
authors.initials: J
authors.lastname: Hyman
authors.forename: T
authors.initials: T
authors.lastname: Eldar-Geva
authors.forename: E
authors.initials: E
authors.lastname: Vatashsky
authors.forename: E
authors.initials: E
authors.lastname: Margalioth
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000698:Analgesia / Q000379:methods*; D002584:Cervix Uteri / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods*; D008012:Lidocaine; D000077442:Lidocaine, Prilocaine Drug Combination; D010147:Pain Measurement; D011318:Prilocaine
chemical_list: D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine