Soriano D, Ajaj S, Chuong T, Deval B, Fauconnier A, Daraï E
Service de Gynécologie, Hôpital Hôtel-Dieu de Paris, Université Paris, Paris, France.
Obstet Gynecol. 2000 Nov;96(5 Pt 1):661-4. doi: 10.1016/s0029-7844(00)00984-4.
To assess the efficacy of lidocaine spray during outpatient hysteroscopy for reducing procedure-related pain and to identify risk factors for discomfort.
One hundred twenty-one women were assigned randomly to have application of lidocaine spray or placebo to the uterine cervix during outpatient hysteroscopy. The main outcome measure was pain during hysteroscopy, assessed on a visual analog scale.
There was no statistically significant difference between study and control groups in mean age, rate of nulliparity, postmenopausal state, need for cervical dilation, or percentage of women who used hormone replacement therapy. Indications for diagnostic hysteroscopy were similar between groups. Women in the lidocaine group had statistically significantly less pain during the procedure than women in the placebo group (2.2 +/- 1.9 and 3.7 +/- 2.5, respectively; P <.001). Women with abnormal uterine findings (submucous myoma, endometrial polyps, or intrauterine adhesions) had significantly higher pain scores than women with normal cavities (2.2 +/- 1.9 and 3.2 +/- 2.4, respectively; P <.002). Aerosol anesthesia and normal uterine findings were independently associated with less pain. No procedure had to be abandoned because of excessive pain or complications, and no women required hospitalization.
Women treated with lidocaine spray had significantly less pain. Uterine cavity abnormality might be associated with a higher degree of pain during hysteroscopy.
评估门诊宫腔镜检查时利多卡因喷雾减轻手术相关疼痛的疗效，并确定不适的危险因素。
121名女性在门诊宫腔镜检查期间被随机分配，在子宫颈处使用利多卡因喷雾或安慰剂。主要结局指标是宫腔镜检查期间的疼痛，采用视觉模拟评分法进行评估。
研究组和对照组在平均年龄、未生育率、绝经状态、宫颈扩张需求或使用激素替代疗法的女性百分比方面，差异无统计学意义。两组间诊断性宫腔镜检查的适应证相似。利多卡因组女性在手术期间的疼痛明显低于安慰剂组女性（分别为2.2±1.9和3.7±2.5；P<.001）。子宫有异常发现（黏膜下肌瘤、子宫内膜息肉或宫腔粘连）的女性疼痛评分明显高于子宫腔正常的女性（分别为2.2±1.9和3.2±2.4；P<.002）。气雾剂麻醉和子宫腔正常与疼痛减轻独立相关。没有因疼痛过度或并发症而不得不放弃手术的情况，也没有女性需要住院治疗。
接受利多卡因喷雾治疗的女性疼痛明显减轻。子宫腔异常可能与宫腔镜检查期间较高程度的疼痛有关。
