Cervical Spray Versus Intracervical Injection in Loop Electrosurgical Excision Procedure: A Randomized Controlled Trial

Abstract

Abstract

Objective: The purpose of this study was to assess the effectiveness of a cervical spray for pain reduction during a loop electrosurgical excision procedure (LEEP). Design: The study was a randomized controlled trial. Materials and Methods: Seventy-two women with abnormal Papanicolaou smears, who were referred to the colposcopy clinic at Khon Kaen Hospital, Muang, Khon Kaen, Thailand, between June and August 2009 and who had indications for LEEP, were recruited. The participants were randomly allocated into two groups. Group 1 received a cervical spray of 1% Xylocaine^® (lidocaine; 5 puffs; 20 mg) onto the cervical epithelium 2 minutes before the procedure. Group 2 received an intracervical injection using a 1% Xylocaine solution (2 mL) into the cervical stroma, at the 3, 6, 9, and 12 o'clock positions, 2 minutes before the procedure. The primary outcome was pain scores. Results: Seventy-two women were analyzed (36 cases in each group). The mean age was 42.2±11.5 years. The average procedure time was 7.9±3.4 minutes. There was no significant difference in median (interquartile range [IQR]) pain score at speculum placement, 1.2 (0.5–3.6) and 0.7 (0.2–1.5) in the cervical-spray and intracervical-injection groups, respectively (p=0.15). Median (IQR) pain scores during LEEP were 5.1 (2.2–8.2) in the cervical-spray group and 1.8 (0.4–5.7) in the intracervical-injection group (p=0.003). Median (IQR) pain scores at 15 minutes after LEEP were 0.9 (0.3–2.3) and 0.3 (0.1–1.0) in the cervical-spray and intracervical-injection groups, with significant difference, p=0.02). There were no serious adverse effects observed. Conclusions: Intracervical injection significantly reduced pain during, and 15 minutes after, LEEP, more than cervical spray did, without serious adverse effects. (J GYNECOL SURG 29:241)