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Am Fam Physician. 2000;62(4):862

Endometrial biopsy is a common office procedure, especially useful for confirming diagnoses associated with abnormal uterine bleeding. Although most women report discomfort with the procedure, few studies have examined the effectiveness of analgesia using local anesthetic agents. Trolice and colleagues compared the effectiveness of intrauterine lidocaine with that of placebo in reducing pain during endometrial biopsy.

Women referred for endometrial biopsy were eligible for the randomized, double-blind trial if they did not have stenosis of the cervical os, evidence of cervicitis or allergy to lidocaine. In addition, results of a pregnancy test (beta human chorionic gonadotropin) had to be negative. Patients were randomized to receive intrauterine pretreatment with 2 percent lidocaine or saline solution. Test solutions were provided as identical 20-mL bottles, and the technique for endometrial sampling was identical in all patients. Immediately following the procedure, each patient completed a visual analog scale assessing pain on a five-point scale and reported any other symptoms experienced during the procedure.

Of the 41 women who completed the study, 19 were treated with lidocaine and 22 with a placebo. Demographic information did not differ statistically in any significant variable. Median pain scores were significantly reduced in the lidocaine group compared with the placebo group. Lightheadedness was reported by two patients in the placebo group, but no adverse effects were reported in the treatment group. Results of pathologic examination of a subset of specimens showed no histologic differences between groups.

The authors conclude that intrauterine lidocaine provides safe and effective pain relief for endometrial biopsy.

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