Vol 93, No 11 (2022)
Research paper
Published online: 2022-06-03

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Effectiveness of paracervical block in endometrial sampling procedures for pain control: a randomized controlled clinical trial

Sabahattin Anil Ari1, Seyda Ceylan Ari2, Ali Akdemir3
Pubmed: 35894487
Ginekol Pol 2022;93(11):889-895.


Objectives: We aimed to evaluate the effect of paracervical block (PCB) on endometrial sampling procedures, to assess
the effect on pain of waiting between PCB and intervention, and to compare the effectiveness of PCB with oral non-steroidal anti-inflammatory drugs (NSAID) for decreasing the pain levels associated with endometrial biopsy.

Material and methods: A total of 123 participants were divided into four groups as Group 1: Waiting 1 minute after PCB, Group 2: Waiting 3 minute after PCB, Group 3: Control group, and Group 4: Waiting 60 minute after taking oral NSAIDs. The success of analgesic measures used for endometrial biopsy during and 30 minutes after the procedure was compared with the Numeric Pain Rating Scale (NPRS) system.

Results: The Numeric Pain Rating Scale (NPRS) 0 score was 2.60 (± 2.42) in Group 1; 1.60 (± 1.73) in Group 2; 5.30 (± 2.10) in Groups 3; 5.63 (± 1.99) in Groups 4. NPRS 30 score was 0.80 (± 0.88) in Group 1; 0.43 (± 0.81) in Group 2; 1.90 (± 1.32) in Groups 3; 2.70 (± 1.41) in Groups 4. The pain was significantly less in the paracervical block groups compared to control and oral NSAIDs groups. However, there was no significant difference in NPRS 0 (p = 0.196) and NPRS 30 (p = 0.191) scores between Group 1 and Group 2. There was no significant difference in NPRS 0 and NPRS 30 scores between control group and oral NSAID group.

Conclusions: Paracervical block (PCB) is an effective method and superior to oral NSAIDs. Waiting 1 minute or 3 minutes after PCB were equally effective.

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  1. Trolice M. Anesthetic efficacy of intrauterine lidocaine for endometrial biopsy: a randomized double-masked trial. Obstetrics & Gynecology. 2000; 95(3): 345–347.
  2. Dogan E, Celiloglu M, Sarihan E, et al. Anesthetic effect of intrauterine lidocaine plus naproxen sodium in endometrial biopsy. Obstet Gynecol. 2004; 103(2): 347–351.
  3. Luangtangvarodom W, Pongrojpaw D, Chanthasenanont A, et al. The Efficacy of Lidocaine Spray in Pain Relief during Outpatient-Based Endometrial Sampling: A Randomized Placebo-Controlled Trial. Pain Research and Treatment. 2018; 2018: 1–5.
  4. Mody SK, Farala JP, Jimenez B, et al. Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial. Obstet Gynecol. 2018; 132(3): 575–582.
  5. Aksoy H, Aksoy U, Ozyurt S, et al. Comparison of lidocaine spray and paracervical block application for pain relief during first-trimester surgical abortion: A randomised, double-blind, placebo-controlled trial. J Obstet Gynaecol. 2016; 36(5): 649–653.
  6. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04572828?term=NCT04572828&draw=2&rank=1 (19.01.2022).
  7. Leclair CM, Zia JK, Doom CM, et al. Pain experienced using two different methods of endometrial biopsy: a randomized controlled trial. Obstet Gynecol. 2011; 117(3): 636–641.
  8. Piątek S, Panek G, Wielgoś M. Assessment of the usefulness of pipelle biopsy in gynecological diagnostics. Ginekol Pol. 2016; 87(8): 559–564.
  9. Tangsiriwatthana T, Sangkomkamhang US, Lumbiganon P, et al. Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cochrane Database Syst Rev. 2013(9): CD005056.
  10. Topdaği YE, Topdagi Yilmaz EP, Aydin ME, et al. Does intravenous lidocaine added to nonsteroidal anti-inflammatory drugs reduce pain during colposcopy? A prospective randomized double-blind study. Ginekol Pol. 2021; 92(12): 844–849.
  11. Einarsson JI, Henao G, Young AE. Topical analgesia for endometrial biopsy: a randomized controlled trial. Obstet Gynecol. 2005; 106(1): 128–130.
  12. Hall G, Ekblom A, Persson E, et al. Effects of prostaglandin treatment and paracervical blockade on postoperative pain in patients undergoing first trimester abortion in general anesthesia. Acta Obstet Gynecol Scand. 1997; 76(9): 868–872.
  13. Hacivelioglu S, Gencer M, Cakir Gungor A, et al. Can the addition of a paracervical block to systemic or local analgesics improve the pain perceived by the patient during hysterosalpingography? J Obstet Gynaecol. 2014; 34(1): 48–53.
  14. Kalkat RK, Cartmill RSV. NovaSure endometrial ablation under local anaesthesia in an outpatient setting: An observational study. J Obstet Gynaecol. 2011; 31(2): 152–155.
  15. Renner RM, Edelman AB, Nichols MD, et al. Refining paracervical block techniques for pain control in first trimester surgical abortion: a randomized controlled noninferiority trial. Contraception. 2016; 94(5): 461–466.
  16. Phair N, Jensen JT, Nichols MD. Paracervical block and elective abortion: the effect on pain of waiting between injection and procedure. Am J Obstet Gynecol. 2002; 186(6): 1304–1307.
  17. Güney M, Oral B, Mungan T. Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy. Int J Gynaecol Obstet. 2007; 97(2): 125–128.
  18. Api O, Ergen B, Api M, et al. Comparison of oral nonsteroidal analgesic and intrauterine local anesthetic for pain relief in uterine fractional curettage: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol. 2010; 203(1): 28.e1–28.e7.