Lidocaine 10% spray reduces pain during hysterosalpingography: a randomized controlled trial

The aim of this study was to evaluate whether the use of lidocaine 10% spray was effective in pain control during hysterosalpingography (HSG).

A total of 81 patients were randomly assigned to three groups: Group 1, 10 mg lidocaine hydrochloride 10% spray; Group 2, 20 mg lidocaine hydrochloride 10% spray; and Group 3, Placebo. We used a standard 10 cm Visual Analog Scale for pain scoring. The '0 cm' end corresponded to 'no pain', and the '10 cm' end represented the 'worst pain ever'. We asked the patients to mark their pre-HSG pain expectancies initially, then to mark their pain during uterine traction after the tenaculum has been applied. Finally, they were asked to mark their pain during contrast medium injection.

In Group1, the mean anticipated pain (AP) score was 64.51 +/- 12.62, the mean pain (MP) score during cervical traction with uterine tenaculum was 57.48 +/- 11.32 (P: 0.011), and the MP score during contrast medium injection was 46.22 +/- 13.00 (P: 0.005). In Group 2 the mean AP score was 66.44 +/- 12.02, the MP score during cervical traction with uterine tenaculum was 48.03 +/- 13.44 (P: 0.001), and the MP during contrast medium injection was 46.25 +/- 11.57 (P: 0.001). In Group 3 the mean AP score was 61.8 +/- 18.5, the MP score during cervical traction with uterine tenaculum was 59.5 (P: 0.07), and the MP during contrast medium injection was 57.5 +/- 14.5) (P: 0.304).

Topical lidocaine spray is a practical and effective analgesic for decreasing pain perception scores during the HSG procedure. A 10 mg dose is comparable to a 20 mg dose in pain reduction with less chance of side effects and better cost-effectiveness.