Abstract
Objective
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.
Study design
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.
Results
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.
Conclusion
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.
Keywords
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References
- Local anaesthesia with a lidocaine/prilocaine cream (EMLA) for cautery of condylomata acuminata on the vulval mucosa. The effect of timing of application of the cream.Acta Derm Venereol. 1989; 69: 362-365
- Duration of analgesia following application of eutectic mixture of local anaesthetics (EMLA) on genital mucosa.Acta Derm Venereol. 1993; 73: 456-458
- Lidocaine-prilocaine (EMLA) cream as analgesia for hysterosalpingography: a prospective, randomized, controlled, double blinded study.Hum Reprod. 2007; 22: 1335-1339
- Pain relief in hysterosalpingography.Cochrane Database Syst Rev. 2007; 2 (Apr 18, Review. PubMed PMID: 17443612): CD006106
- Pain relief in office gynaecology: a systematic review and meta-analysis.Eur J Obstet Gynecol Reprod Biol. 2011; 155: 3-13
- Lidocaine–prilocaine (EMLA(®)) cream as analgesia in hysteroscopy practice: a prospective, randomized, non-blinded, controlled study.Acta Obstet Gynecol Scand. 2013; 92: 978-981
- Transcervical intrauterine topical local anesthetic at hysterosalpingography: a prospective, randomized, double-blind, placebo-controlled trial.Fertil Steril. 2002; 78: 1116-1122
- Pain relief during hysterosalpingography: role of intracervical block.Arch Gynecol Obstet. 2013; 287: 155-159
- Fertility: assessment and treatment for people with fertility problems.National Institute for Health and Clinical Excellence, Manchester2013
- Intracervical block and pain perception during the performance of a hysterosalpingogram: a randomized controlled trial.Obstet Gynecol. 2007; 109: 89-93https://doi.org/10.1097/01
- Local anesthesia of the genital mucosa with a lidocaine/prilocaine cream (EMLA) for laser treatment of condylomata acuminata: a placebo-controlled study.Obstet Gynecol. 1990; 75: 302-306
- A double-blind, randomized, placebo-controlled trial of prilocaine and felypressin (Citanest and Octapressin) for the relief of pain associated with cervical biopsy and treatment with the Semm coagulator.J Low Genit Tract Dis. 2005; 9: 171-175
- The effect of topical lignocaine gel in pain relief for colposcopic assessment and biopsy: is it useful?.Br J Obstet Gynaecol. 2008; 115: 1057-1060
- Clinically oriented anatomy.6th ed. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia2010
- Use of local anesthesia for office diagnostic and operative hysteroscopy.J Minim Invasive Gynecol. 2010; 17: 709-718
- Fast-release orodispersible tramadol as analgesia in hysterosalpingography with a metal cannula or a balloon catheter.Hum Reprod. 2010; 25: 1451-1457
- Fear no pain: uterine cavity and tubal patency assessment tests should be pain free.Ultrasound Obstet Gynecol. 2012; 39: 247-251
Article info
Publication history
Published online: September 29, 2014
Accepted:
September 22,
2014
Received in revised form:
September 19,
2014
Received:
June 9,
2014
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
