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2015 ; 7
(ä): 833-9
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Randomized comparative trial of cervical block protocols for pain management
during hysteroscopic removal of polyps and myomas
#MMPMID26543383
Lukes AS
; Roy KH
; Presthus JB
; Diamond MP
; Berman JM
; Konsker KA
Int J Womens Health
2015[]; 7
(ä): 833-9
PMID26543383
show ga
PURPOSE: To evaluate the efficacy of two cervical block protocols for pain
management during hysteroscopic removal of intrauterine polyps and myomas using
the MyoSure(®) device. PATIENTS AND METHODS: This was a randomized, comparative
treatment trial conducted by five private Obstetrics and Gynecology practices in
the USA. Forty premenopausal women aged 18 years and older were randomized to
receive either a combination para/intracervical block protocol of 37 cc local
anesthetic administered at six injections sites in association with the
application of topic 1% lidocaine gel, or an intracervical block protocol of 22
cc local anesthetic administered at three injections sites without topical
anesthetic, for pain management during hysteroscopic removal of intrauterine
polyps and/or a single type 0 or type 1 submucosal myoma ?3 cm. The main outcomes
were a composite measure of procedure-related pain and pain during the
postoperative recovery period, assessed by the Wong-Baker Faces Rating Scale (0=
no pain to 10= maximum pain). The lesion characteristics, procedure time, and
adverse events were summarized. RESULTS: A total of 17 polyps and eight myomas
were removed in the para/intracervical block group, with diameters of 1.3±0.5 cm
and 1.8±0.8 cm, respectively. In the intracervical block group, 25 polyps with a
mean diameter of 1.2±0.7 cm and 7 myomas with a mean diameter of 1.9±0.9 cm were
removed. The mean tissue resection time was 1.2±2.0 minutes and 1.2±1.4 minutes
for the para/intracervical and intracervical block groups, respectively. The mean
composite procedure-related pain score was low for both cervical block protocols,
1.3±1.4 in the para/intracervical block group vs 2.1±1.5 in the intracervical
block group. During the postoperative recovery period, the mean pain scores were
0.3±0.7 vs 1.2±1.7 for the para/intracervical and intracervical block groups,
respectively. There were no serious adverse events. CONCLUSION: The MyoSure
procedure for removal of polyps and myomas was well tolerated, with low pain
scores reported for both the para/intracervical and intracervical block
protocols.