title: Analgesic efficacy of forced coughing versus local anesthesia during cervical punch biopsy.
abstract: OBJECTIVE
  To compare local anesthesia and forced coughing in terms of subjective pain perception during cervical punch biopsy.
  
  
  METHODS
  In this randomized controlled trial, 114 patients (mean age: 38.9 ± 9.0 years) scheduled for colposcopically directed cervical punch biopsy were randomly assigned to local anesthesia (n = 39), forced coughing (n = 39) and control (n = 36) groups. Pain perception was measured on a 10-cm visual analog scale (VAS) during the insertion of the speculum, injection of the local anesthetic to the cervix and the taking of the first cervical biopsy, as well as for the overall pain perceived during the entire procedure.
  
  
  RESULTS
  Experimental groups were similar in age, gravidity, parity and prior curettage. The pain score obtained during the first cervical biopsy was significantly lower if local anesthesia was applied (p = 0.016). Groups were similar in other pain subscores. The duration of the entire procedure was significantly longer (p < 0.001) in the local anesthesia group, while it was not significantly different in forced coughing patients compared to controls.
  
  
  CONCLUSIONS
  Local anesthesia, but not forced coughing, provides significant pain relief during cervical biopsy. Based on similarity to control data in terms of pain relief and shortening of the operation, forced coughing per se seems related neither to pain relief nor a faster cervical biopsy.
authors: Department of Obstetrics and Gynecology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Kartal, Istanbul, Turkey. mmuratnaki@yahoo.com
authors: M Murat
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