title: Comparison of interventions for pain control with tenaculum placement: a randomized clinical trial.
abstract: OBJECTIVE
  Although previous studies have demonstrated that a variety of local anesthetics are effective to decrease pain associated with tenaculum placement, no studies directly compare an injection with a topical anesthetic. The objective of this study was therefore to compare mean pain scores with tenaculum placement after an intracervical lidocaine injection or topical lidocaine gel.
  
  
  METHODS
  A randomized, single-blinded trial of women presenting for office gynecologic procedures that required a tenaculum. Women aged 18 years or older were randomized to receive either a 1% lidocaine intracervical injection or topical application of 2% lidocaine gel to the cervix immediately prior to tenaculum placement. The primary outcome was pain at the time of tenaculum placement, measured on a 100 mm Visual Analog Scale. Secondary outcomes included pain with the intervention and satisfaction with tenaculum placement.
  
  
  RESULTS
  Seventy-four women were enrolled and randomized; 35 subjects in each group met criteria for analysis. The two groups had similar socio-demographic characteristics. Women who received the injection had lower mean pain levels at tenaculum placement [12.3 mm (S.D. 17.4 mm) versus 36.6 mm (S.D. 23.0 mm), p<.001] but higher mean pain levels with study drug application [20.4 mm (S.D. 19.4 mm) versus 5.9 mm (S.D. 8.6 mm), p<.001]. Satisfaction with tenaculum placement was similar for the two groups.
  
  
  CONCLUSIONS
  Mean pain with tenaculum placement is lower after receiving a lidocaine injection than after receiving a topical lidocaine gel. Satisfaction with tenaculum placement is similar with both interventions.
authors.affiliation: Department of Obstetrics & Gynecology, University of Colorado, Aurora, CO, USA. Electronic address: lisa.goldthwaite@ucdenver.edu.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Goldthwaite
authors.affiliation: Oregon Health & Science University (OHSU), Portland, OR, USA.
authors.forename: Maureen K
authors.initials: MK
authors.lastname: Baldwin
authors.affiliation: University of Utah, Salt Lake City, UT, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Page
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Micks
authors.affiliation: Oregon Health & Science University (OHSU), Portland, OR, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Nichols
authors.affiliation: Oregon Health & Science University (OHSU), Portland, OR, USA.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Edelman
authors.affiliation: Oregon Health & Science University (OHSU), Portland, OR, USA.
authors.forename: Paula H
authors.initials: PH
authors.lastname: Bednarek
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002584:Cervix Uteri / Q000187:drug effects; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D006176:Gynecology / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D020702:Hysteroscopes; D007434:Intrauterine Devices; D008012:Lidocaine / Q000008:administration & dosage; D059408:Pain Management; D010147:Pain Measurement; D016037:Single-Blind Method
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Analgesia; Cervix; Gel; Injection; Lidocaine