Clinical Question: Do intrauterine lidocaine, oral naproxen, or both, lead to better pain control for endometrial sampling?

Setting: Outpatient (primary care)

Study Design: Randomized controlled trial (double-blinded)

Synopsis: Oral analgesia is recommended frequently to decrease the pain of endometrial sampling in the medical office. Intrauterine anesthesia also is promising. In this study, 120 women undergoing pipelle aspiration for endometrial sampling were randomized to one of four groups: (1) local lidocaine plus oral naproxen; (2) lidocaine with placebo oral analgesia; (3) placebo anesthesia (sterile saline) with oral naproxen; or (4) both treatment placebos. Local lidocaine in a dose of 5 mL of 2 percent solution was given via an 18-gauge angiocatheter sheath. Syringe and sheath were left in place for three minutes and then withdrawn. Naproxen sodium was given as a single 550-mg oral dose one hour before the procedure.

Women rated their pain during the procedure on a 10-cm visual analog scale. Mean pain scores were lower in the lidocaine plus naproxen group than in the placebo group (4.6 versus 7.1, P <.05), a clinically relevant difference. Mean pain scores were intermediate and not statistically different from placebo or combined treatment in the lidocaine-only and naproxen-only groups (5.9 and 5.8, respectively).

Bottom Line: The combination of intrauterine lidocaine plus oral naproxen sodium significantly decreases pain associated with endometrial sampling in the medical office. (Level of Evidence: 1b)