Paracervical anaesthesia in outpatient hysteroscopy: a randomised double‐blind placebo‐controlled trial

OBJECTIVE: To evaluate the efficacy and safety of paracervical anaesthesia in reducing pain during outpatient hysteroscopy and endometrial biopsy. DESIGN: Prospective, randomised, placebo-controlled, double-blind study. POPULATION: One hundred women undergoing outpatient hysteroscopy and endometrial biopsy for abnormal uterine bleeding. INTERVENTIONS: Paracervical block using 10 mL of either 2% lignocaine or normal saline before the procedure. MAIN OUTCOME MEASURES: Evaluation of pain at different stages of hysteroscopy using a visual analogue scale together with blood pressure and heart rate monitoring. RESULTS: Compared with placebo, paracervical anaesthesia significantly reduced the pain only at the time of insertion of the hysteroscope, but not at the subsequent stages of the procedure. However, paracervical injection of lignocaine resulted in a higher incidence of bradycardia and hypotension. CONCLUSIONS: Paracervical anaesthesia not only fails to reduce pain during outpatient hysteroscopy and endometrial biopsy, but also carries a risk of inducing bradycardia and hypotension, which is probably a result of inadvertent intravascular injection.