Methods of pain control during endometrial biopsy: A systematic review and meta‐analysis of randomized controlled trials

Kittipat Charoenkwan, Chalaithorn Nantasupha
In: Journal of Obstetrics and Gynaecology Research · 2019 · vol. 46(1) , pp. 9–30 · doi:10.1111/jog.14152 · PMID:31667985 · W2982506801
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This systematic review and meta-analysis found that intrauterine lidocaine, anesthetic spray, paracervical block, and oral NSAIDs effectively reduced pain during endometrial biopsy.

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Abstract

AIM: To review effectiveness of methods for reducing pain during endometrial biopsy. METHODS: statistic. For meta-analysis of pain scores, weighted mean difference with 95% confidence interval (CI) were estimated. RESULTS: Twenty-six studies were included in the review. Marginally significant reduction in the pain score during the procedure in participants with intrauterine lidocaine relative to control was observed (mean difference [MD] -1.31, 95% confidence interval [CI] -2.70 to 0.09, P = 0.07). Subgroup analysis showed that in studies that used low-pressure suction devices, intrauterine lidocaine was associated with statistically significant reduction in pain during the procedure (MD -2.22, 95% CI -3.72 to -0.73, P = 0.004). There was a significantly lower pain score during biopsy in the anesthetic spray group compared to control (MD -0.96, 95% CI -1.53 to -0.39, P = 0.001). Significant heterogeneity on types of intervention and outcome measures among studies that examined paracervical block and nonsteroidal anti-inflammatory drugs (NSAID) was observed. However, paracervical block and NSAID were associated with significant pain reduction compared to placebo in most of the related studies. CONCLUSION: Intrauterine anesthetics, anesthetic cervical spray, paracervical block and oral NSAID provide effective pain control during endometrial biopsy.

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