A Randomized Double Blind Placebo Controlled Study to Assess the Efficacy of Fundal Block Analgesia During Radiofrequency Endometrial Ablation.
Dinusha T Hamilton, Sarah Smith, Huse Kamencic et al.
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In 30 seconds
This single-centre, double-blind, placebo-controlled randomised trial assessed whether hysteroscopic fundal lidocaine block reduces intraoperative pain during ambulatory NovaSure endometrial ablation. It included 100 premenopausal patients with abnormal uterine bleeding, allocated to 10 mL 1% lidocaine or saline. With parenteral conscious sedation and paracervical block, pain scores did not differ significantly between groups at 30 seconds, 60 seconds, or one hour after the procedure. In a subgroup with self-reported dysmenorrhea, placebo recipients had higher pain scores at 30 and 60 seconds. Overall acceptability and adverse events were similar.
Key findings
- Pain scores did not differ between lidocaine and placebo at 30 seconds, 60 seconds, or one hour (p = .08; p = .28; p = .09).
- Among participants reporting dysmenorrhea, placebo was associated with higher pain scores than lidocaine at 30 and 60 seconds (p = .02; p = .03).
- Overall, 95.6% would recommend the procedure; recommendation rates did not differ between groups.
- There were no between-group differences in intraoperative analgesic or sedative use, postoperative pain, or adverse events.
Why it matters
The trial suggests that adding a fundal lidocaine block does not improve pain scores for the overall population when conscious sedation and paracervical block are already used. The subgroup result raises the possibility of benefit for patients with dysmenorrhea, but it is a secondary analysis and should be interpreted cautiously.
What to keep in mind
The study was conducted at a single centre. The potential benefit in patients with dysmenorrhea comes from a secondary subgroup analysis.