Hum. Reprod. Advance Access published online on January 18, 2007
Human Reproduction, doi:10.1093/humrep/del517
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Lidocaine–Prilocaine (EMLA) cream as analgesia for hysterosalpingography: a prospective, randomized, controlled, double blinded study
1 Department of Obstetrics and Gynecology 2 Department of Anesthesia, Shaare Zedek Medical Center, Jerusalem, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheba, Israel
3 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem. E-mail: liberg{at}013.net.il
BACKGROUND: The aim of our study is to evaluate the efficacy of applying lidocaine 25 mg–prilocaine-25 mg/G cream (EMLA 5%) on the uterine cervix for pain relief when performing hysterosalpingography (HSG).
METHODS: Eighty-two patients undergoing HSG as part of infertility evaluation were randomized into groups receiving EMLA (42) or placebo cream (40) in a double-blinded prospective study from which four women were later excluded. The cream was applied to the uterine cervix by means of a cervical cup 30 min before the HSG. Pain perception related to the HSG procedure was scored by visual analogue scale (VAS) at five predefined steps: after speculum application, after cervical instrumentation of the tenaculum and cannula, at the end of uterine filling, at completion of tubal spillage, and immediately following instrument removal. In addition, the patients were asked to retrospectively rate the pain during the entire procedure in a telephone interview the following day.
RESULTS: Cervical instrumentation was found to be the most painful step of HSG (P < 0.001). When comparing the VAS pain scores, cervical instrumentation in the EMLA-treated patients was associated with significantly less pain than the control group: 3.3 ± 2.9 versus 4.9 ± 2.7, respectively (P = 0.02).
CONCLUSION: Topical application of EMLA 5% cream on the uterine cervix before performing HSG significantly reduced the pain during this procedure.
Key words: hysterosalpingography/local anaesthetic/pain relief/uterine cervix/visual analogue scale
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