The risk and inconvenience associated with laparoscopic tubal sterilization are reduced by transcervical sterilization because it can be performed in the outpatient setting and does not require entry into the peritoneal cavity. Although the procedure is generally well tolerated, the pain experienced during transcervical sterilization has not been evaluated in well-controlled studies. Women undergoing the procedure experience variable amounts of pain; this may limit its acceptability as an office-based procedure. A number of well-designed trials have demonstrated that use of intrauterine lidocaine decreases patient perception of pain during several office intrauterine procedures, but have not evaluated its possible benefits for prevention of pain with transcervical sterilization.
This randomized, double-blind, placebo-controlled trial was designed to determine whether intrauterine lidocaine before transcervical sterilization would reduce patient pain during and after the procedure. About 30 to 45 min before the procedure, 58 patients were premedicated with 800 mg of oral ibuprofen, 2 mg of oral lorazepam, and a paracervical block with 10 mL of 1% lidocaine. Three minutes before insertion of the hysteroscope, subjects were randomized to receive either an intrauterine infusion of 5 mL of 4% lidocaine (n = 29) or saline (n = 29). Patients rated their perceived pain using a 100-mm visual analog scale (scores ranged from 0 [no pain] to 100 mm [worst imaginable]) at set time points before and after the procedure. To obtain additional safety data on the use of intrauterine lidocaine in the nonpregnant uterus, serum lidocaine levels were determined in a subset of 39 subjects.
There was no significant difference between the lidocaine study group and the placebo group in pain scores (P = 0.34) or in mean levels of lidocaine. None of the patients in either treatment group reported symptoms of lidocaine toxicity. At 20 minutes after infusion, 1 patient in the lidocaine group had the highest lidocaine level (4022 ng/mL). Symptoms in this patient resolved without treatment.
These findings show that administration of intrauterine lidocaine before outpatient transcervical sterilization does not decrease pain.
From the Department of Obstetrics and Gynecology and Center for Biostatistics, The Ohio State University, Columbus, OH; and Department of Obstetrics and Gynecology and Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR