title: Randomized comparative trial of cervical block protocols for pain management during hysteroscopic removal of polyps and myomas.
abstract: OBJECTIVE
  To evaluate the efficacy of two cervical block protocols for pain management during hysteroscopic removal of intrauterine polyps and myomas using the MyoSure(®) device.
  
  
  METHODS
  This was a randomized, comparative treatment trial conducted by five private Obstetrics and Gynecology practices in the USA. Forty premenopausal women aged 18 years and older were randomized to receive either a combination para/intracervical block protocol of 37 cc local anesthetic administered at six injections sites in association with the application of topic 1% lidocaine gel, or an intracervical block protocol of 22 cc local anesthetic administered at three injections sites without topical anesthetic, for pain management during hysteroscopic removal of intrauterine polyps and/or a single type 0 or type 1 submucosal myoma ≤3 cm. The main outcomes were a composite measure of procedure-related pain and pain during the postoperative recovery period, assessed by the Wong-Baker Faces Rating Scale (0= no pain to 10= maximum pain). The lesion characteristics, procedure time, and adverse events were summarized.
  
  
  RESULTS
  A total of 17 polyps and eight myomas were removed in the para/intracervical block group, with diameters of 1.3±0.5 cm and 1.8±0.8 cm, respectively. In the intracervical block group, 25 polyps with a mean diameter of 1.2±0.7 cm and 7 myomas with a mean diameter of 1.9±0.9 cm were removed. The mean tissue resection time was 1.2±2.0 minutes and 1.2±1.4 minutes for the para/intracervical and intracervical block groups, respectively. The mean composite procedure-related pain score was low for both cervical block protocols, 1.3±1.4 in the para/intracervical block group vs 2.1±1.5 in the intracervical block group. During the postoperative recovery period, the mean pain scores were 0.3±0.7 vs 1.2±1.7 for the para/intracervical and intracervical block groups, respectively. There were no serious adverse events.
  
  
  CONCLUSIONS
  The MyoSure procedure for removal of polyps and myomas was well tolerated, with low pain scores reported for both the para/intracervical and intracervical block protocols.
authors.affiliation: Carolina Women's Research and Wellness Center, Durham, NC, USA.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Lukes
authors.affiliation: Phoenix Gynecology Consultants, Phoenix, AZ, USA.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Roy
authors.affiliation: Minnesota Gynecology and Surgery, Edina, MN, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Presthus
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Diamond
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Berman
authors.affiliation: Florida Woman Care, Boca Raton, FL, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Konsker
keywords: MyoSure; hysteroscopic morcellation; myomectomy; polypectomy