The efficacy of lidocaine–prilocaine cream (EMLA®) analgesia in the practice of hysterosalpingography is controversial. This study
provides new drill results and a new method of application in terms of mode, time
and place. The aim of the paper is to investigate the efficacy of 5% lidocaine 25 mg–prilocaine 25 mg/g cream applied to the uterine cervix for reducing pain during hysterosalpingography.
A randomized, double blinded, controlled study set in the general gynaecology clinic
of a university teaching hospital between September 2012 and June 2013. One hundred
successive patients programmed to undergo hysterosalpingography were randomized to
either 3 ml of EMLA (50) cream or 3 ml of placebo (50), placed endocervically and exocervically, 10 min before hysterosalpingography. Patients’ intensity of pain was assessed in four
steps: at baseline (speculum application), after application of Pozzi tenaculum and
cannula on the uterine cervix, during cervical traction and after contrast medium
injection, using a 10-cm Visual Analogue Scale (VAS) immediately after the procedure.
The most painful step was also identified. VAS was administered again at one-month
follow-up visit. Trial registration: NCT01303614.
The contrast medium injection was the most painful step of hysterosalpingography in
both groups (EMLA 3.96, placebo 4.54, 95%CI: −0.481 to 1.641). No differences were
found between the two groups (P = 0.281) during this step. When comparing the VAS scale after the application of Pozzi
tenaculum and cannula (EMLA 1.06, placebo 3.34, 95%CI: 1.495–3.065) and after cervical
traction (EMLA 2.54, placebo 3.46, 95%CI: 0.034–1.806), significantly less pain was
experienced by the EMLA group than the placebo group: P = 0.000 and P = 0.042, respectively.
Endocervical and exocervical topical application of EMLA 10 min before performing hysterosalpingography significantly reduced pain during cervical
manipulation with tenaculum and cannula and during cervical traction, but did not
reduce pain during injection of contrast that was the most painful step.