Karaman Erbil, Kolusarı Ali, Alkış İsmet, Çetin Orkun
a Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Medical Faculty , Yuzuncu Yil University , Van , Turkey.
b Department of Obstetrics and Gynecology, Medical Faculty , Yuzuncu Yil University , Van , Turkey.
J Obstet Gynaecol. 2019 May;39(4):534-538. doi: 10.1080/01443615.2018.1538329. Epub 2019 Jan 11.
Our objective was to compare the effectiveness of local lidocaine spray (LS) compared to forced coughing (FC) for relieving the pain during colposcopically guided cervical biopsies (CGBs). The study was a randomised study, which included patients with abnormal cervical cytologic results requiring a colposcopic biopsy procedure. The patients were randomly assigned to either the 10% LS or the FC groups before the biopsy procedure. As a primary outcome, the pain was assessed by using a 10 cm visual analogue scale at the different steps during the procedure. Forty-four and 42 patients had CGBs using LS and FC, respectively. The age, parity, body mass index, history of previous curettage and vaginal delivery, smoking status and the number of biopsies were similar in both groups. The mean ± SD pain scores after the cervical biopsy were 3.25 ± 1.4 and 4.4 ± 1.3 in the LS and FC groups, respectively (p< .05). The operative time was longer in the LS than in the FC group (7.6 ± 1.4 vs. 5.2 ± 0.8, p: .004). No complication or adverse effect was observed in both groups. The present study showed that LS use can be recommended for pain relief during colposcopically directed cervical biopsy procedure with a superiority to the FC in the terms of pain and absence of any adverse reactions. Impact Statement What is already known on this subject? A colposcopic-guided cervical biopsy is a painful procedure and different techniques have been proposed to relieve this pain with conflicting results. Studies have demonstrated that a forced coughing is a good and easy method for relieving pain with some disadvantages. Local lidocaine spray (LS) is another option for pain relief during the biopsy procedure. However, no randomised study has compared these two methods yet. What the results of this study add? The results from this randomised study suggest that LS has superiority in terms of pain relief during the colposcopic biopsy procedure and has no adverse reactions. What the implications are of these findings for clinical practice and/or further research? The evidence from different studies showed some conflicting results regarding the pain relief methods during the colposcopic biopsy procedure. The local LS can be used in this procedure in routine clinical practice. However, further studies with larger samples and comparison of different methods are needed.
我们的目的是比较局部利多卡因喷雾（LS）与用力咳嗽（FC）在阴道镜引导下宫颈活检（CGB）过程中缓解疼痛的效果。该研究为一项随机研究，纳入了宫颈细胞学检查结果异常且需要进行阴道镜活检的患者。在活检前，患者被随机分配至10% LS组或FC组。作为主要结局指标，在操作的不同阶段使用10厘米视觉模拟量表评估疼痛程度。分别有44例和42例患者使用LS和FC进行CGB。两组患者的年龄、产次、体重指数、既往刮宫和阴道分娩史、吸烟状况以及活检次数相似。宫颈活检后，LS组和FC组的平均±标准差疼痛评分分别为3.25±1.4和4.4±1.3（p<0.05）。LS组的手术时间比FC组长（7.6±1.4对5.2±0.8，p：0.004）。两组均未观察到并发症或不良反应。本研究表明，在阴道镜引导下的宫颈活检过程中，使用LS缓解疼痛是可取的，在疼痛缓解方面优于FC，且无任何不良反应。影响声明关于该主题已知的信息有哪些？阴道镜引导下的宫颈活检是一种痛苦的操作，人们提出了不同的技术来缓解这种疼痛，但结果相互矛盾。研究表明，用力咳嗽是一种缓解疼痛的简便方法，但存在一些缺点。局部利多卡因喷雾（LS）是活检过程中缓解疼痛的另一种选择。然而，尚无随机研究比较这两种方法。本研究的结果增加了什么？这项随机研究的结果表明，在阴道镜活检过程中，LS在缓解疼痛方面具有优势，且无不良反应。这些发现对临床实践和/或进一步研究有何意义？不同研究的证据显示，在阴道镜活检过程中，关于疼痛缓解方法的结果存在一些相互矛盾之处。局部LS可在常规临床实践中用于该操作。然而，需要进行更大样本量的进一步研究以及不同方法的比较。
