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ysteroscopy has become a standard investigation for a
lot of gynecological cases and found to be effective in
detecting intrauterine pathology and treating it . It is usually
performed as an outpatient procedure under either local or no
It is associated with some degree of pain and carries a
risk of a vaso-vagal reaction. Pain is the commonest reason for
failure to complete the procedure. Although paracervical
anesthesia is useful for local ablation of the cervix and suction
evacuation of the uterus, it has not been shown to reduce pain
during hysteroscopy in randomized trials suggesting that the
use of local anesthesia may reduce the pain.
Local anesthetic techniques are being used at an increasing
rate in modern gynecology. The increased expense of hospital
admission has caused many gynecologists to perform operative
hystrescopy employing local anesthesia in offices and clinics.
Direct cervical stromal infiltration or uterosacral
ligament block have been most often used for operations on
the uterine cervix and corpus; but these methods are seldom
totally effective, they required expertise for consistent good
results, and potentially toxic doses of anesthetic agents are
required in these vascular areas where direct venous injection
and systemic toxicity are constant hazards.General anesthesia
is discouraged, especially for more minor procedures because
of the associated risks and attendant
The aim of the current study is to compare between the
effect of intracornual nerve block versus placebo in reducing
pain & discomfort during operative hysteroscopy.
The study was conducted at the Early Cancer
Detection and Endoscopy Unit (Ain Shams University
Hospital) where 58 patients fulfilling the criteria of the study
was recruited from the gynecology outpatient clinic of the
After enrollment, an informed written consent was taken
from all participants before recruitment in the study and after
explaining the purpose, possible risks and complications of
different procedures carried out in the study.
The patient were randomly categorized into two groups :
group A : patients receive corneal nerve block using local
anathesia during operative procedure.
group B : patients receive placebo in the form of normal
saline instead of local anathesia in the hystroscopic injection.
29 patients underwent polypectomy.
10 patients underwent septal resection.
3 patients underwent missed IUD removal.
Pain reported during procedure via visual analogue
scale (VAS) from 0 to 10.
Secondary outcome :
The need for postoperative analgesia (non-steroidal,
opioids, paracetamol), duration of hospital stay.
Pain experienced during the procedure (traction of
cervix, introduction of hysteroscopy, during the procedure, on
withdrawal and after procedure) was evaluated using VAS to
assess the pain experienced during surgical procedures.
In the current study, there was no statistically significant
differences between women of both groups regarding age, body
mass index or frequency distribution of type of hysteroscopic
Visual analogue score for assessment of intra-operative
pain was statistically significantly lower in the LA-ICOB group
compared to the placebo-ICOB group. In the same context, the
number of patients requiring extra analgesia (either as NSAIDs
or opioid analgesics) was statistically significantly larger in the
placebo-ICOB group compared to the LA-ICOB group.
No statistically significant differences were found
between both groups regarding duration of postoperative
This study proved that the use of intracornual nerve
block in operative hysteroscopy is both beneficial and
effective in reducing pain and discomfort that could associate
operative hysteroscopy procedure