A Multimodal Approach toward Pain Relief during Dilatation and Curettage: A Randomized Clinical Study

Introduction: Dilatation and curettage (D&C) is one of the most common minor procedures in gynecology performed mainly as an outpatient basis procedure for the evaluation of abnormal uterine bleeding (AUB). Various forms of analgesia used include local anesthesia like paracervical block (PCB) or intracervical block, intrauterine instillation of local anesthetic agent, rectal/oral/parenteral use of nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids, sedatives and hypnotics, and even general anesthesia. This study was undertaken to compare various routes of local analgesia for the D&C procedure. Aim: The aim of this study was to compare the pain scores before and after administering the local anesthetic agent 2% lidocaine in D&C procedure. Design: The design of this study includes a prospective interventional study (September 2016 to August 2018) in 220 AUB patients attending gynaecology clinics of Kasturba Hospital, Manipal, Karnataka, India. Method: The visual analog scale (VAS) was used for pain assessment, and SPSS16 was used for data analysis. Result: During cervical dilatation, paracervical block has better pain relief and during curettage intrauterine instillation lidocaine provides adequate pain control, and the combined use of paracervical and intrauterine lidocaine is superior for pain relief and also provides long-lasting pain relief even following the procedure. Conclusion: Lidocaine administration is safe, effective, and can be a good alternative to other forms of analgesia, both regional and general.