Effectiveness of intrauterine anesthesia for pain relief during fractional curettage

OBJECTIVE: To study the effectiveness of intrauterine anesthesia for pain relief during fractional curettage. METHODS: A double-blinded, randomized, placebo-controlled trial was conducted in 66 patients with abnormal uterine bleeding undergoing fractional curettage under paracervical block, using 10-mL 1% lidocaine plus intrauterine 5-mL 2% lidocaine (n = 33) or saline (n = 33). The primary outcome was the maximum pain score measured with a 10-cm visual analog scale. Other outcomes measured included pain profile, number of patients with pain score more than 4, each patient's global satisfaction index, adverse events, and serum lidocaine profile. RESULTS: The 2 groups were comparable in age, body mass index, education, socioeconomic status, menopausal status, and parity. Compared with the saline group, the lidocaine group had a significantly lower median value for the maximum pain score (2.3 versus 4.7, P = .022) and fewer patients with a pain score more than 4 (33.3% versus 60.6%, P = .026). The pain scores were lower at the endocervical curettage and the uterine curettage steps. There was no difference between the 2 groups in other outcomes. The number needed to treat to prevent a case with a pain score more than 4 was 3.7 (95% confidence interval 2.4-38.5). CONCLUSION: The addition of intrauterine anesthesia to paracervical block can further reduce pain during fractional curettage without increasing adverse effects. LEVEL OF EVIDENCE: I.     

分段诊刮中运用宫内麻醉减轻疼痛的有效性

目的：旨在研究分段诊刮中运用宫内麻醉减轻疼痛的有效性。方法：在66例行分段诊刮出现异常子宫出血的患者中进行一项双盲、随机、安慰剂对照试验，受试者分为两组，分别使用1％的利多卡因10ml子宫旁神经阻断麻醉加2％的利多卡因5ml宫内麻醉（n=33）和子宫旁神经阻断麻醉加盐水对照宫内麻醉（n=33）。主要观察指标为依据10cm目视疼痛评分表评估的最大疼痛评分，其他观察指标包括疼痛评估曲线、疼痛指数〉4的患者数、每例患者的整体满意指数、副作用及血清利多卡因曲线图。结果：两组患者在年龄、体重指数、受教育程度、社会经济地位、停经状况、产次等方面无叫显差异。     

Clinical and pathological responses of progestin therapy for non-atypical endometrial hyperplasia: a prospective study

AIMS: To evaluate the clinical and pathological responses and factors predicting non-responders to various progestins currently prescribed for the treatment of non-atypical endometrial hyperplasia. METHODS: A prospective observational study was conducted in the Gynecologic Endocrinology Unit, Faculty of Medicine, Siriraj Hospital, Thailand, from 1998 to 2003. A 6-month course of progestin therapy was offered to all patients. The clinical response was evaluated from the vaginal bleeding pattern during the first 4 months of treatment. The pathological response was evaluated from the histopathology of the endometrium after completion of the 6-month therapy. RESULTS: Of 250 registered patients, the number of cases qualified for the evaluation of the clinical and pathological response were 198 and 134 cases, respectively, revealing the overall clinical and pathological response rates of 93.4% and 92.5%, respectively. Among 13 clinical non-responders, 84.6% might have associated pelvic pathology. Among 10 pathological non-responders, three had surgical treatment, and progressive disease was found in one case. Significant factors predicting clinical non-responders included a history of prior bleeding (odds ratio [OR] = 8.79, 95% confidence interval [CI] = 1.63, 47.53), the presence of associated pelvic pathology (OR = 25.52, 95% CI = 3.21, 203.01), and treatment using progestins other than medroxyprogesterone acetate. Factors predicting pathological non-responders were not statistically significant. CONCLUSIONS: The current regimens of progestin therapy for non-atypical endometrial hyperplasia have high response rates. Patients who fail to have a clinical response should be evaluated for associated pelvic pathology. Follow-up endometrial biopsy should be offered to the patients, because 7.5% have persistent or progressive lesions, necessitating aggressive treatment.