Literature Review Article
Local anesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis. Cooper, N.A., Khan, K.S., Clark, T.J. BMJ 2010 March. 340: c1130.
Dr. John Preston Parry, M.D., M.P.H.
The authors performed a systematic review and meta-analysis of randomized controlled trials assessing the efficacy of local anesthetic techniques for outpatient (conscious) hysteroscopy. The four approaches assessed relative to no treatment or placebo were intracervical, paracervical, transcervical (into the uterine cavity), and topical anesthesia. Out of 247 citations identified, after adjusting for control group selection, data formatting that could be used in a meta-analysis, and other inclusion criteria, 15 were eligible for the meta-analysis. Using standardized mean differences, both intracervical and paracervical techniques were found to improve analgesia in a statistically significant fashion, but transcervical and topical did not show such benefit. Meta-regression analysis showed that paracervical anesthesia was statistically superior to the other three techniques, including intracervical. The authors concluded that paracervical anesthesia is the preferred technique when performing local anesthesia for conscious outpatient hysteroscopy. (Note, however, that one study not part of the meta-analysis showed hysteroscopy performed via vaginoscopy was significantly less painful than the traditional approach of speculum placement and local anesthesia.)
Dr. Meike Uhler, M.D.
In many practices, office hysteroscopy has become an important means of patient evaluation. Optimizing pain control during these procedures is paramount. This meta-analysis demonstrates that paracervical anesthesia provides the best means of achieving that control compared with other methods.