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Paracervical Block Efficacy in Office Hysteroscopic Sterilization: A Randomized Controlled Trial

Chudnoff, Scott MD, MS; Einstein, Mark MD, MS; Levie, Mark MD

doi: 10.1097/AOG.0b013e3181c51ace
Original Research

OBJECTIVE: To estimate the efficacy of paracervical block compared with saline for pain relief during office hysteroscopic sterilization.

METHODS: This study was a randomized, placebo-controlled study of women desiring hysteroscopic sterilization. A paracervical block of 1% lidocaine or normal saline was administered before office hysteroscopic sterilization. Patients and investigators were blinded to assignments. A pre hoc power analysis determined that 40 women would be required per arm to detect a difference of 0.9 cm on a visual analog scale. Pain was recorded on a visual analog scale at multiple procedure time points. Individualized standardized pain scores were constructed by weighted reporting of objective and subjective sensation.

RESULTS: A total of 103 consecutive women were eligible, and 80 women were randomized, with 40 per group. Thirty-seven (93%) in each group had successful placement. The lidocaine group showed significantly lower pain scores for tenaculum placement (mean±standard deviation: 0.97±1.28 compared with 3.00±2.41, P<.001) traversing the external cervical os (1.46±1.71 compared with 3.77±2.68, P<.001) and internal os (1.79±2.11 compared with 4.10±2.77, P<.001). There was no significant observed difference with device placement in tubal ostium (3.15±2.69 compared with 3.74±2.73, P=.33). Multivariable linear regression analysis demonstrated a relationship of pain to procedural time (P=.047) and to group assignment (P<.01).

CONCLUSION: Paracervical block with 1% lidocaine provides effective pain relief for cervical manipulations during office hysteroscopic sterilization, but does not reduce the pain associated with upper uterine/tubal manipulation when placing the devices.



Paracervical block provides adequate pain relief for cervical manipulation, but it does not provide significant relief for upper uterine manipulation.

From Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.

Corresponding author: Scott Chudnoff, MD, MS, Centennial Women's Center, Montefiore Medical Center, 3332 Rochambeau Avenue, Bronx, NY 10467; e-mail:

Financial Disclosure: Dr. Levie serves on the medical advisory board for Conceptus (Mountain View, CA). The other authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists.