A randomized trial of outpatient hysteroscopy with and without intrauterine anesthesia

Study objective: To evaluate the amount of pain during office hysteroscopy and endometrial biopsy with and without intrauterine anesthesia. Design: Prospective randomized study (Canadian Task Force classification I). Setting: Academic teaching center. Patients: A total of 82 women underwent outpatient hysteroscopy for evaluation of their uterine cavity. Interventions: Randomization to local cervical or combined cervical and intrauterine anesthesia. Measurements and main results: Amount of pain experienced during the procedure; 10, 30, and 60 minutes after the procedure; and during endometrial biopsy. We used a visual analog scale ranging from 0 to 10 (0: no pain, 10: excruciating pain). Of 82 patients, 4 patients were excluded, 36 patients underwent hysteroscopy using local cervical anesthesia, and 42 others with combined cervical and intrauterine anesthesia. The mean age of the patients in the local group was 37.4 +/- 0.8 years and in the combined group was 38.3 +/- 0.7 years. In both groups, patients experienced significantly more pain during and 10 minutes after the procedure than 30 and 60 minutes after. No significant differences occurred in the pain scores during the hysteroscopy, and 10, 30, and 60 minutes after between the 2 anesthesia groups. The pain score in the local group during endometrial biopsy was significantly higher than during (p<0.5), 10 minutes after (p<.001), 30 minutes after (p<.001), and 60 minutes after (p<.001) the procedure, respectively. In the combined group, compared with the pain score during endometrial biopsy, the scores during the hysteroscopy (p<.05), 10 minutes after (p<.01), 30 minutes after (p<.001), and 60 minutes after (p<.001) the procedure were also less, respectively. Conclusion: Intrauterine anesthesia with medicated saline as a distending medium is ineffective. Endometrial biopsy is associated with more pain that hysteroscopy.