E-ISSN: 2619-9467

Contents    Cover    Publication Date: 30 Apr 2020
Year 2020 - Volume 30 - Issue 1

Open Access

Peer Reviewed

ORIGINAL RESEARCH
1545 Viewed895 Downloaded

Can Rectal Indomethacin Be an Alternative Local Anesthetic Method to Intrauterine Lidocaine During Endometrial Biopsy? A Clinical Observational Prospective Study

Full Text PDF  
J Clin Obstet Gynecol. 2020;30(1):14-9
DOI: 10.5336/jcog.2020-73612
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: Endometrial biopsy is a pain-related gynecological procedure. The aim of this study is to compare the efficacy of rectal indomethacin and intrauterine lidocaine on pain control during endometrial sampling. Material and Methods: This clinical observational prospective trial was conducted in 120 patients with the complaint of abnormal uterine bleeding who presented at İstanbul Medeniyet University Göztepe Training and Research Hospital, Obstetrics and Gynecology Department, between January 2017 and June 2017. Patients were divided into two groups. The rectal group had 64 patients, to whom indomethacin was given as a local anesthetic. The intrauterine group had 56 patients, for whom lidocaine was the local anesthetic used. Endometrial biopsy was performed by using a no. 4 Karman cannula. The primary goal of measurement was pain intensity assessed by a visual analog scale before, during, and 10 minutes after the procedure. Results: There were no statistically significant differences between the two groups in mean age, body mass index, weight and median levels of gravidity, parity and abortion. The median pain scores of the two groups during and 10 minutes after the procedure were similar (p > 0.05). Conclusion: In this study, rectal indomethacin was shown to be equal to intrauterine anesthesia for reducing pain during the endometrial biopsy. Rectal indomethacin may be an alternative drug to relieve pain during gynecological procedures. Further researches with larger numbers of patients are needed to confirm our findings.
REFERENCES:
  1. Spencer C, Whitehead MI. Endometrial assessment re-visited. Br J Obstet Gynaeol. 1999;106(7):623-32. [Crossref]  [PubMed] 
  2. Mercier RJ, Zerden ML. Intrauterine anesthesia for gynecologic procedures: a systematic review. Obstet Gynecol. 2012;120(3):669-77. [Crossref]  [PubMed]  [PMC] 
  3. Cooper JM, Erickson ML. Endometrial sampling techniques in the diagnosis of abnormal uterine bleeding. Obstet Gynecol Clin North Am. 2000;27(2):235-44. [Crossref] 
  4. Cengiz H, Dağdeviren H, Kaya C, Yeşil A, Çaypınar SS. Comparing the efficacy of intrauterine lidocaine and paracervical block in decreasing the pain associated with endometrial biopsy: a randomised trial. Arch Gynecol Obstet. 2014;289(3):609-14. [Crossref]  [PubMed] 
  5. Trolice MP, Fishburne Jr C, McGrady S. Anesthetic efficacy of intrauterine lidocaine for endometrial biopsy: a randomized double- masked trial. Obstet Gynecol. 2000;95(3):345-7. [Crossref]  [PubMed] 
  6. Lau WC, Lo WK, Tam WH, Yuen PM. Paracervical anaesthesia in outpatient hysteroscopy: a randomised double-blind placebo-controlled trial. Br J Obstet Gynaecol. 1999;106(4):356-9. [Crossref]  [PubMed] 
  7. Lau WC, Tam WH, Lo WK, Yuen PM. A randomised double-blind placebo-controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy. BJOG. 2000;107(5):610-3. [Crossref]  [PubMed] 
  8. Zupi E, Luciano AA, Valli E, Marconi D, Maneschi F, Romanini C. The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy. Fertil Steril. 1995;63(2):414-6. [Crossref] 
  9. Cicinelli E, Didonna T, Ambrosi G, Schönauer LM, Fiore G, Matteo MG. Topical anaesthesia for diagnostic hysteroscopy and endometrial biopsy in postmenopausal women: a randomised placebo-controlled double-blind study. Br J Obstet Gynaecol. 1997;104(3): 316-9. [Crossref]  [PubMed] 
  10. Nagele F, Lockwoodb G, Magos AL. Randomised placebo controlled trial of mefenamic acid for premedication at outpatient hysteroscopy: a pilot study. Br J Obstet Gynaecol. 1997;104(7):842-4. [Crossref]  [PubMed] 
  11. Senturk MB, Guraslan H, Babaoğlu B, Yaşar L, Polat M. The effect of intrauterine lidocaine and rectal indomethacin on pain during office vaginoscopic hysteroscopy: randomized double-blind controlled study. Gynecol Obstet Invest. 2016;81(3):280-4. [Crossref]  [PubMed] 
  12. Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4(7):407-14. [Crossref] 
  13. Güler A, Şahin HG, Küçükaydın Z, Erdemoğlu E. Comparison of the efficacy of intrauterine lidocaine, paracervical block and oral etodolac for decreasing pain in endometrial biopsy. J Turk Ger Gynecol Assoc. 2010;11(4):178-81. [Crossref]  [PubMed]  [PMC] 
  14. Edelman A, Nichols MD, Leclair C, Astley S, Shy K, Jensen JT. Intrauterine lidocaine infusion for pain management in first-trimester abortions. Obstet Gynecol. 2004;103(6):1267-72. [Crossref]  [PubMed] 
  15. Loza AM, Lomeli XR, Correa JG, Cobain CD, Guevara GC, Munoz FM, et al. Effect of the rectal administration of indomethacin on amylase serum levels after endoscopic retrograde cho- langiopancreatography, and its impact on the development of secondary pancreatitis episo- des. Rev Esp Enferm Dig. 2007;99(6):330-6.
  16. Tammaro S, Caruso R, Pallone F, Monteleone G. Post-endoscopic retrograde cholangio-pancreatography pancreatitis: is time for a new preventive approach? World J Gastroenterol. 2012;18(34):4635-8. [Crossref]  [PubMed]  [PMC]