title: Hysteroscopic local anaesthetic intrauterine cornual 'focal local' block before endometrial ablation with direct cervical block in an outpatient setting: a feasibility study.
abstract: OBJECTIVE
  To evaluate the safety, feasibility and efficacy of a hysteroscopic local anaesthetic intrauterine cornual block (ICOB) on women's perception of pain during outpatient Thermachoice endometrial ablation (TEA).
  
  
  METHODS
  Pre-menopausal women with heavy menstrual bleeding undergoing TEA were included in the study. The intervention used, ICOB, was a hysteroscopic injection of local anaesthetic into the myometrium just medial to each tubal ostium. The women also had a traditional direct cervical block (DCB). We measured the acceptability of ICOB and the pain score (visual analogue score scale) immediately after the procedure.
  
  
  RESULTS
  We treated 30 patients (mean age 41 years, SD 6; BMI 29±7) between January 2012 and December 2012. All patients had a successful ICOB block and found TEA with ICOB acceptable. The mean VAS score was 3.5±2.7, which was two points lower compared to our earlier prospective cohort of patients undergoing TEA with only a DCB (mean 5.8±2.7, n=102). No serious complications occurred during the procedure or postoperatively. Three patients experienced a vasovagal response which resolved spontaneously.
  
  
  CONCLUSIONS
  ICOB with DCB is a safe, feasible and efficacious method of pain control during TEA. There is however a need to evaluate efficacy of ICOB in a randomised placebo controlled trial.
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Vinod
authors.initials: V
authors.lastname: Kumar
authors.forename: Janesh Kumar
authors.initials: JK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000772:Anesthesia, Local / Q000379:methods*; D055356:Endometrial Ablation Techniques; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D010147:Pain Measurement; D011446:Prospective Studies
keywords: Direct cervical block; Endometrial ablation; Intrauterine cornual block; Local anaesthesia; Thermachoice ablation