Safety and efficacy of intrauterine lidocaine compared to warm isotonic sodium chloride solution for the control of pain during office hysteroscopy: a randomized controlled trial

OBJECTIVE: To compare the effectiveness of intrauterine lidocaine and warm isotonic sodium chloride solution as distension media for pain reduction during office hysteroscopy. METHODS: This triple-blind randomized controlled trial included 100 patients undergoing diagnostic office hysteroscopy. They were randomized into either the isotonic sodium chloride solution group, which underwent hysteroscopy using warmed isotonic sodium chloride solution as the distension medium, or the lidocaine group, which underwent hysteroscopy using 5 mL of 2% lidocaine diluted in warmed isotonic sodium chloride solution as the distension medium. The primary outcome was the pain visual analog scale score during and after the procedure. RESULTS: The pain scores reported throughout the procedure (during insertion, visualization, and withdrawal) and 15 minutes after the procedure were significantly lower in patients in the lidocaine group compared with those in the isotonic sodium chloride solution group (1.9±1.0 vs. 3.1±0.8, 1.5±0.8 vs. 2.5±0.8, 1.7±0.8 vs. 2.8±0.7, and 1.1±0.2 vs. 1.7±0.8, respectively). Regarding complications, there were no differences between the two study groups in the reported cases of vaginal bleeding (1 vs. 2) or vasovagal reactions (0 vs. 1), and there were no reported cases of uterine perforation or creation of a false tract. Regarding side effects, significantly fewer patients in the lidocaine group experienced lower abdominal pain, nausea, and headache compared with those in the isotonic sodium chloride solution group. CONCLUSION: The addition of lidocaine to isotonic sodium chloride solution as the distension medium during office hysteroscopy was associated with low pain scores during and after the procedure, short procedure time, reduced need for additional analgesia, high patient satisfaction, and low procedural difficulty scores.