Paracervical block efficacy in office hysteroscopic sterilization: a randomized controlled trial.
OBJECTIVE
To estimate the efficacy of paracervical block compared with saline for pain relief during office hysteroscopic sterilization.


METHODS
This study was a randomized, placebo-controlled study of women desiring hysteroscopic sterilization. A paracervical block of 1% lidocaine or normal saline was administered before office hysteroscopic sterilization. Patients and investigators were blinded to assignments. A pre hoc power analysis determined that 40 women would be required per arm to detect a difference of 0.9 cm on a visual analog scale. Pain was recorded on a visual analog scale at multiple procedure time points. Individualized standardized pain scores were constructed by weighted reporting of objective and subjective sensation.


RESULTS
A total of 103 consecutive women were eligible, and 80 women were randomized, with 40 per group. Thirty-seven (93%) in each group had successful placement. The lidocaine group showed significantly lower pain scores for tenaculum placement (mean+/-standard deviation: 0.97+/-1.28 compared with 3.00+/-2.41, P<.001) traversing the external cervical os (1.46+/-1.71 compared with 3.77+/-2.68, P<.001) and internal os (1.79+/-2.11 compared with 4.10+/-2.77, P<.001). There was no significant observed difference with device placement in tubal ostium (3.15+/-2.69 compared with 3.74+/-2.73, P=.33). Multivariable linear regression analysis demonstrated a relationship of pain to procedural time (P=.047) and to group assignment (P<.01).


CONCLUSIONS
Paracervical block with 1% lidocaine provides effective pain relief for cervical manipulations during office hysteroscopic sterilization, but does not reduce the pain associated with upper uterine/tubal manipulation when placing the devices.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00811187.


METHODS
I.
Chudnoff
Scott
S
From Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Einstein
Mark
M
Levie
Mark
M
D000328:Adult; D000553:Ambulatory Care; D000773:Anesthesia, Obstetrical / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008012:Lidocaine / Q000008:administration & dosage; D015999:Multivariate Analysis; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D013245:Sterilization, Reproductive; D055815:Young Adult
D000779:Anesthetics, Local; D008012:Lidocaine