Outpatient hysteroscopy with combined local intracervical and intrauterine anesthesia

To evaluate the degree of pain during and after office hysteroscopy with combined intracervical and intrauterine anesthesia compared to intracervical anesthesia only.

We evaluated the amount of pain experienced during office hysteroscopy using combined local intracervical and intrauterine anesthesia, 10, 30, and 60 min after, and during endometrial biopsy prospectively in 37 infertile women (study group). We used a visual analog scale ranging from 0 to 10. Seventy-six women who received only intracervical anesthesia served as historical controls.

The mean ages of patients in the control and study groups were comparable. Patients' perception of pain was significantly higher during endometrial biopsy than during or after hysteroscopy in the study patients (p < 0.01, 95% CI 0-3). The mean pain score in the control group was significantly higher than that in the study group during hysteroscopy (3.3 +/- 0.2 vs. 2.2 +/- 0.3; p < 0.05, 95% CI 0-2). However, there was no significant difference in the pain scores between the control and study groups during endometrial biopsy and 10, 30, and 60 min after the procedure.

Endometrial biopsy is associated with more pain than office hysteroscopy. Additional intrauterine anesthesia with 1% lidocaine significantly reduces pain sensation during office hysteroscopy.