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Optimizing analgesia for endometrial biopsy: A prospective, randomized comparative study.

Enes Serhat Coskun1, Ali Selcuk Yeniocak2, Havva Betul Bacak3

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Intrauterine lidocaine and paracervical block effectively manage pain during endometrial biopsy (EMB). These methods significantly reduce discomfort compared to oral dexketoprofen or cervical lidocaine spray, improving patient experience.

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Area of Science:

  • Gynecology
  • Pain Management
  • Pharmacology

Background:

  • Endometrial biopsy (EMB) is a common gynecological procedure.
  • Pain during EMB can impact patient tolerance and compliance.
  • Effective pain management strategies are crucial for outpatient gynecological procedures.

Purpose of the Study:

  • To compare the efficacy of four different analgesic methods for pain control during outpatient endometrial biopsy (EMB).
  • To evaluate intrauterine lidocaine, oral dexketoprofen, cervical lidocaine spray, and paracervical block with prilocaine.
  • To determine the optimal pain management approach for patient comfort.

Main Methods:

  • A prospective, randomized, observational study involving 197 women undergoing EMB.
  • Participants were assigned to one of four groups: intrauterine lidocaine, oral dexketoprofen, cervical lidocaine spray, or paracervical block with prilocaine.
  • Pain intensity was measured using a visual analog scale (VAS) post-procedure, with additional analgesia needs recorded.

Main Results:

  • Intrauterine lidocaine and paracervical block demonstrated significantly lower pain scores compared to lidocaine spray and oral dexketoprofen (p < 0.001).
  • The oral dexketoprofen group reported the highest pain scores, with more frequent severe pain.
  • No additional analgesia was required in the intrauterine lidocaine or paracervical block groups, unlike the lidocaine spray group (30%).

Conclusions:

  • Intrauterine lidocaine and paracervical block are superior to lidocaine spray and oral dexketoprofen for managing pain during endometrial biopsy.
  • Appropriate selection of analgesia is vital for enhancing patient comfort during office-based gynecological procedures.
  • These findings support the use of regional or intrauterine anesthesia for improved procedural outcomes.