Lidocaine Spray Versus Paracervical Block During Loop Electrosurgical Excision Procedure: A Randomized Trial

Objective: The aim of the study was to compare the effectiveness of pain control between lidocaine spray (LS) and paracervical block (PB) with lidocaine during the loop electrosurgical excision procedure (LEEP). Materials and Methods: A single-blinded randomized controlled trial was conducted on 132 women who underwent LEEP of the cervix. The participants were randomly allocated to either a PB group or a LS group. The PB group participants were anesthetized by PB using 10 mL of 2% lidocaine with 1:100,000 of epinephrine. The LS group participants were locally anesthetized with four puffs (40 mg) of 10% LS, which was applied thoroughly to the cervix. Pain scores, using 10-cm visual analog scales, were obtained and compared for participants in both groups during anesthesia, during excision and 30 minutes after excision. Results: A total of 132 LEEPs were performed with 66 in LS group and 66 in PB group. The mean (SD) pain scores during excision were 5.2 (2.4) in the LS group and 4.2 (3.3) in the PB group (mean difference = 1.1, 95% CI = 0.8 to 2.1, p = .033), which was within the nonclinically significant margin of this study. The baseline pain score after speculum examination was not significantly different in both groups. There was no adverse effect in the LS group compared with eight cases in the PB group (tinnitus, numbness, palpitation or tachycardia, and hypertension). Conclusions: The local 40 mg of 10% LS can be used to substitute for PB for pain control during LEEP of the cervix. It also resulted in fewer adverse effects.