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Am Fam Physician. 2001;63(9):1822

Hysteroscopy has become widely used to investigate uterine abnormalities, but the procedure is associated with severe pain in 15 to 30 percent of women. Some researchers have suggested the use of intracervical or paracervical nerve blocks, but these take time and have small risks of infection or intravasation. Soriano and colleagues studied the efficacy of local lidocaine spray in reducing pain and discomfort during outpatient hysteroscopy.

The authors studied 121 consecutive women who were scheduled for diagnostic hysteroscopy at a French teaching hospital. Exclusions included significant hepatic, respiratory or cardiac disease; epilepsy; active menorrhagia at the time of the procedure; and contraindication to lidocaine. The women were randomly assigned to treatment with 5 percent lidocaine spray or an identical placebo five minutes before hysteroscopy. An independent nurse who was unaware of the treatment assignment assisted all patients with the use of a visual analog scale to record discomfort. Patients completed the scale during and immediately after the procedure.

Data were not collected on three patients. The 62 women who were given anesthetic were comparable to the 56 women who received placebo in age, parity, menopausal status, indication for the procedure, use of tenaculum and use of hormone replacement therapy. Overall, the women who received anesthetic reported significantly lower pain scores than those in the placebo group, even after adjustment for abnormal uterine findings. No procedures were abandoned because of pain, and no patients required additional analgesia. All women left the clinic within one hour of the end of the procedure.

The authors conclude that lidocaine spray effectively reduces pain and discomfort during outpatient hysteroscopy, even in patients with intrauterine abnormalities. The spray was painless, easy to use and not associated with bleeding or intravasation.

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