Optimizing analgesia for endometrial biopsy: A prospective, randomized comparative study.

Aim: This prospective, randomized, observational study aimed to compare the efficacy of intrauterine lidocaine, oral dexketoprofen, cervical lidocaine spray, and paracervical block with prilocaine for pain management during outpatient endometrial biopsy (EMB).

Methods: One hundred ninety-seven women aged 18-75 undergoing EMB were randomly assigned to one of four groups: intrauterine lidocaine (n = 49), oral dexketoprofen (n = 48), cervical lidocaine spray (n = 50), or paracervical block with prilocaine (n = 50). Pain intensity was assessed using a visual analog scale (VAS) immediately post-procedure and at 30 min, with additional analgesia needs recorded at 60 min. Statistical analyses included Kruskal-Wallis, chi-square tests, and post hoc analysis.

Results: The intrauterine lidocaine group had the lowest pain scores, while oral dexketoprofen had the highest (p < 0.001). Intrauterine lidocaine and paracervical block scores were significantly lower than those in the lidocaine spray and dexketoprofen groups (p < 0.001). Additional analgesia was needed in 30% of the lidocaine spray group, with none required in other groups. Severe pain (VAS ≥5.8) was more frequent in the dexketoprofen group compared to others (p < 0.001).

Conclusion: Intrauterine lidocaine and paracervical block are more effective than lidocaine spray and oral dexketoprofen in reducing procedural pain during EMB, highlighting the importance of appropriate analgesic selection to enhance patient comfort in office-based gynecological procedures.