Lidocaine vaginal gel versus lidocaine paracervical block for analgesia during oocyte retrieval

BACKGROUND: Evidence from randomized trials suggests that pain relief during oocyte retrieval is superior when adjunctive paracervical block is used in addition to sedation alone. Vaginal application of lidocaine gel is a non-invasive alternative to lidocaine paracervical block. The goal of the present trial was to compare analgesia with lidocaine vaginal gel versus lidocaine paracervical block. METHODS: A parallel-group randomized trial of adjunctive lidocaine vaginal gel versus adjunctive lidocaine paracervical block (with sedation for both groups) was performed in participants undergoing oocyte retrieval. Measured outcomes were subjective pain experiences. Subjects provided self-reported ratings of pain and anxiety. Visual analogue scales were used to measure pain during different procedural stages. The McGill Pain Questionnaire was used to measure pain character and the total pain experience. RESULTS: During application of lidocaine, pain ratings were less for vaginal gel than paracervical block. In contrast, during insertion of the aspiration needle and aspiration of follicles, pain ratings were greater for lidocaine vaginal gel. Total pain experience was greater with lidocaine vaginal gel. CONCLUSIONS: Subjective measures of pain intensity and the total pain experience were greater with lidocaine vaginal gel compared with lidocaine paracervical block.