Lidocaine-prilocaine (EMLA®) Cream in Hysteroscopy Practice: a Prospective, Randomized, Non-blinded, Controlled Study

Abstract

Summary T hisstudywasdoubleblindplacebo-controlledtoevaluatetheefficacyofatopicalanestheticcreamEMLA.Inreducingpainanddiscomfortassociatingoutpatienthysteroscopywhenappliedontheuterinecervix.SixtyPatientswereincluded,randomlywereallocatedintotwogroupsequalinsize,premeditationcounselingwasperformedinthewaitingroombeforetheproceduresothatthepatientswouldbecooperativewiththeresearcher.Fullmedicalhistoryandclinicalexaminationwerecarriedoutbeforetheprocedure,sothatnoitemoftheexclusioncriteriacouldbemissed.Everypatientwasinterviewedprivatelybytheresearcherimmediatelyaftertheproceduretoassesspainexperiencedduringtheprocedure,using"PainIntensityScale",toassessacceptabilityofthecreamused,1and5minaftertheprocedureandtoassessthepreferenceforthecreamusedandwhethertheywouldrecommendthesamecreamtobeusedifhysteroscopyprocedurecouldbeindicatedinfuture.TherewerenoSignificantdifferencesinpersonalhistory,menstrualorobstetrichistory,physicalorlocalexamination.Thecreamwasapplied5-10minutesbeforetheprocedureandpainwasassessedona4-pointscaleforthefourstagesoftheprocedure: Speculum insertion.Placementofthetenaculum,progressionthroughcervicalcanal.andevaluationoftheuterinecavity.ForallthelastthreestagestheassociatedpainwassignificantlylessinEMLAgroupcomparedwiththeplacebogroup(p<.001).Althoughcervicalentrancewasdifficultin8patientsinEMLAgroupandin9patientsintheplacebogroup,butthiswasduetotheRVFpositionoftheiruterithatdictatedthesurgeontopullonthetenaculumforciblyupsothattherigidhysteroscopecouldenterstrait.Therewasnosignificantdifferenceintimeforuterineevaluationinbothgroups,AlthoughthemeanuterineevaluationtimewasslightlylongerinEMLAgroupthantheplacebogroup,thiscouldbeexplainedbythegreateaseandcomfortofanestheticcreamthatcausethepatientsmorerelaxedandcooperative.