title: Lidocaine-prilocaine cream as analgesia for hysterosalpingography: a randomized, double blinded, controlled study.
abstract: OBJECTIVE
  The efficacy of lidocaine-prilocaine cream (EMLA(®)) analgesia in the practice of hysterosalpingography is controversial. This study provides new drill results and a new method of application in terms of mode, time and place. The aim of the paper is to investigate the efficacy of 5% lidocaine 25 mg-prilocaine 25 mg/g cream applied to the uterine cervix for reducing pain during hysterosalpingography.
  
  
  METHODS
  A randomized, double blinded, controlled study set in the general gynaecology clinic of a university teaching hospital between September 2012 and June 2013. One hundred successive patients programmed to undergo hysterosalpingography were randomized to either 3 ml of EMLA (50) cream or 3 ml of placebo (50), placed endocervically and exocervically, 10 min before hysterosalpingography. Patients' intensity of pain was assessed in four steps: at baseline (speculum application), after application of Pozzi tenaculum and cannula on the uterine cervix, during cervical traction and after contrast medium injection, using a 10-cm Visual Analogue Scale (VAS) immediately after the procedure. The most painful step was also identified. VAS was administered again at one-month follow-up visit.
  
  
  BACKGROUND
  NCT01303614.
  
  
  RESULTS
  The contrast medium injection was the most painful step of hysterosalpingography in both groups (EMLA 3.96, placebo 4.54, 95%CI: -0.481 to 1.641). No differences were found between the two groups (P=0.281) during this step. When comparing the VAS scale after the application of Pozzi tenaculum and cannula (EMLA 1.06, placebo 3.34, 95%CI: 1.495-3.065) and after cervical traction (EMLA 2.54, placebo 3.46, 95%CI: 0.034-1.806), significantly less pain was experienced by the EMLA group than the placebo group: P=0.000 and P=0.042, respectively.
  
  
  CONCLUSIONS
  Endocervical and exocervical topical application of EMLA 10 min before performing hysterosalpingography significantly reduced pain during cervical manipulation with tenaculum and cannula and during cervical traction, but did not reduce pain during injection of contrast that was the most painful step.
authors.affiliation: Department of Obstetrics and Gynaecology, Consorci Sanitari de Terrassa, Crta. Torrebonica s/n, 08227 Terrassa, Barcelona, Spain. Electronic address: barnau@cst.cat.
authors.forename: Baldomero
authors.initials: B
authors.lastname: Arnau
authors.affiliation: Department of Epidemiology, Consorci Sanitari de Terrassa, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Jovell
authors.affiliation: Department of Obstetrics and Gynaecology, Consorci Sanitari de Terrassa, Crta. Torrebonica s/n, 08227 Terrassa, Barcelona, Spain.
authors.forename: Marino
authors.initials: M
authors.lastname: Romero
authors.affiliation: Department of Pharmacy, Consorci Sanitari de Terrassa, Barcelona, Spain.
authors.forename: Manuela
authors.initials: M
authors.lastname: Gonzalez
authors.affiliation: Department of Radiology, Consorci Sanitari de Terrassa, Barcelona, Spain.
authors.forename: Lola
authors.initials: L
authors.lastname: Esteba
authors.affiliation: Department of Radiology, Consorci Sanitari de Terrassa, Barcelona, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: Garcia
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local; D003287:Contrast Media / Q000008:administration & dosage; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000009:adverse effects / Q000379:methods*; D007267:Injections / Q000009:adverse effects; D008012:Lidocaine; D000077442:Lidocaine, Prilocaine Drug Combination; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011318:Prilocaine
chemical_list: D000779:Anesthetics, Local; D003287:Contrast Media; D004338:Drug Combinations; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine
keywords: Administration, Topical; Anaesthetics; Hysterosalpingography; Pain; Visual analog scale