Lignocaine aerosol spray in outpatient hysteroscopy: a randomized double-blind placebo-controlled trial

Objective: To assess the efficacy of lignocaine spray during outpatient hysteroscopy in reducing the need for additional anesthesia and reducing the discomfort of the procedure. Design: A randomized double-blind, placebo-controlled trial. Setting: An undergraduate university teaching hospital in London. Patient(s): One hundred twenty patients undergoing outpatient hysteroscopy. Intervention(s): Application of lignocaine spray to the cervix, cervical canal, and uterine cavity during outpatient hysteroscopy. Main Outcome Measure(s): The need to use additional anesthesia and the pain experienced at various steps of the procedure. Result(s): Women treated with active spray experienced significantly less pain when the cervix was grasped with a tenaculum at the start of hysteroscopy. There were no other significant differences in the outcome of hysteroscopy between the placebo and lignocaine groups, although there was a significant reduction in the use of additional anesthesia in both groups compared with historical controls. Conclusion(s): Lignocaine spray has beneficial effects on cervical but not uterine sensation. Pretreatment with either lignocaine or placebo seems to reduce the need for additional intracervical anesthesia during hysteroscopy.