The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy.

STUDY OBJECTIVE: To determine whether the pain and discomfort of routine hysteroscopy with endometrial biopsy to diagnose infertility and endometrial pathology can be minimized by topical application of mepivacaine.

DESIGN: Prospective, randomized, double-blind study.

SETTING: The Department of Obstetrics and Gynecology at a teaching hospital in Rome, Italy.

PATIENTS: Eighteen women undergoing diagnostic hysteroscopy.

INTERVENTIONS: Hysteroscopy and endometrial biopsy were performed after transcervical injection of 5 ml 2% mepivacaine or 5 ml saline solution into the uterine cavity.

MEASUREMENTS AND MAIN RESULTS: Difficulty introducing the hysteroscope was rated by the operator on a scale of 1 to 3. An observer scored visible signs of each woman's distress using a three-point scale. The patients reported their pain 15, 30, 60, 120 minutes after the procedure on a visual analog scale. Mepivacaine was more effective than placebo according to all measurements.

CONCLUSIONS: Topical mepivacaine reduced the pain experienced during and after hysteroscopy and endometrial biopsy.