Hysteroscopy Anesthesia for Relief of Pain

NCT ID: NCT07178379

Last Updated: 2025-09-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-06

Study Completion Date

2025-12-31

Brief Summary

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This randomized clinical trial aims to evaluate the effect of local anesthesia on pain perception in patients undergoing outpatient diagnostic hysteroscopy. Although generally well tolerated, pain during hysteroscopy remains a leading cause of procedural failure and patient discomfort. Current evidence on the effectiveness of local anesthetic techniques is limited, with considerable variability in study designs, patient populations, and outcomes measured.

This study will compare pain levels between two groups: one receiving local anesthetic infiltration (3% mepivacaine into the uterosacral ligaments), and the other undergoing a placebo-like intervention (saline irrigation without injection). Pain will be assessed using a standardized Visual Analog Scale (VAS).

The primary objective is to determine whether local anesthesia significantly reduces pain perception during the procedure. Secondary objectives include evaluating which patient or procedural variables may influence pain (e.g., parity, uterine position, BMI, operator experience) and whether local anesthesia impacts the need for post-procedural analgesia or complication rates.

Patients will be randomly assigned in a 1:1 ratio using a simple randomization method. Although the study design does not allow for double blinding, efforts will be made to minimize expectation bias-patients will not be explicitly informed whether they are receiving anesthesia or not, and the placebo group will receive simulated intervention. The principal investigator and the statistician will be blinded to the treatment allocation during data analysis.

Inclusion criteria are: age ≥ 18 years, indication for office-based diagnostic hysteroscopy or minor operative procedures (e.g., polypectomy or biopsy), and no previous hysteroscopy experience. Exclusion criteria include known anesthetic allergy, complex procedures (e.g., myomectomy), anatomic uterine malformations, severe complications, or lack of consent.

A total sample size of 58 patients (29 per group) has been calculated based on an expected clinically relevant VAS difference of 1.5 points and a standard deviation of 2.0. To account for possible dropouts, up to 70 patients may be enrolled.

The results of this trial will provide higher quality evidence on whether local anesthesia should be routinely recommended in outpatient hysteroscopy and may support cost-effectiveness studies in the future.

Detailed Description

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Conditions

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Pain Management Outpatient Hysteroscopy Local Anesthesia Procedural Pain Relief Gynecologic Procedure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
This is a single-blind study with partial masking. Patients will not be explicitly informed whether they are receiving local anesthesia or placebo. In the control group, a simulated intervention (saline irrigation of the cervix and vagina) will be performed to mimic the anesthetic procedure. However, due to the nature of the intervention (injection of anesthetic vs. no injection), full blinding of patients is not feasible.

The healthcare provider administering the intervention is not blinded, but both the principal investigator and the statistician will be blinded to group allocation during data analysis. This aims to reduce observer and analysis bias

Study Groups

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Control

Patients in the control group will undergo a placebo-like intervention in which the vagina and cervix will be irrigated with 0.9% normal saline using a syringe, simulating the motion and timing of the anesthetic application without actual injection. This aims to reduce expectation bias. No active anesthetic agent will be used.

Intervention Type: Placebo Comparator Substance: Saline (0.9% sodium chloride) Route: Vaginal and cervical irrigation Purpose: To serve as the control arm for comparison of pain levels in patients not receiving anesthetic injections.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type OTHER

Procedure:

Vaginal and cervical irrigation with 0.9% saline solution (4 irrigations, mimicking anesthesia administration).

Mimicry:

Same equipment (syringe, speculum) as intervention group. Identical patient positioning and timing

Local Anesthesia (Mepivacaine 3%)

Patients in this group will receive an injection of 3% mepivacaine into the uterosacral ligaments before undergoing diagnostic hysteroscopy. The anesthetic will be administered using a 25 mm Carpule needle, with 3.4 mL injected into each uterosacral ligament under standard gynecological positioning. The procedure will begin approximately one minute after administration to allow time for the anesthetic effect.

Intervention Type: Drug Drug Name: Mepivacaine 3% Dose and Route: Local injection - 6.8 mL total (3.4 mL per side) Purpose: To assess the effect of local anesthesia on pain perception during outpatient hysteroscopy.

Group Type EXPERIMENTAL

Local paracervical Anesthesia

Intervention Type PROCEDURE

1\. Intervention Group (Local Anesthesia) Name: Mepivacaine 3% uterosacral ligament block Type: Pharmacological (local anesthetic).

Dose/Administration:

Drug: Mepivacaine hydrochloride 3% (4 vials of 1.7 mL each, total 6.8 mL). Route: Bilateral injection into uterosacral ligaments (2 injections per ligament, 3.4 mL per side).

Technique:

Patient in lithotomy position. Uterosacral ligaments identified posteriorly to the cervix. Injection with a 27G Carpule needle (25 mm length) at 2-3 mm depth. Slow infusion (to minimize dispersion). Timing: Administered ≥1 minute before hysteroscopy.

Interventions

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Local paracervical Anesthesia

1\. Intervention Group (Local Anesthesia) Name: Mepivacaine 3% uterosacral ligament block Type: Pharmacological (local anesthetic).

Dose/Administration:

Drug: Mepivacaine hydrochloride 3% (4 vials of 1.7 mL each, total 6.8 mL). Route: Bilateral injection into uterosacral ligaments (2 injections per ligament, 3.4 mL per side).

Technique:

Patient in lithotomy position. Uterosacral ligaments identified posteriorly to the cervix. Injection with a 27G Carpule needle (25 mm length) at 2-3 mm depth. Slow infusion (to minimize dispersion). Timing: Administered ≥1 minute before hysteroscopy.

Intervention Type PROCEDURE

Placebo

Procedure:

Vaginal and cervical irrigation with 0.9% saline solution (4 irrigations, mimicking anesthesia administration).

Mimicry:

Same equipment (syringe, speculum) as intervention group. Identical patient positioning and timing

Intervention Type OTHER

Other Intervention Names

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local anesthesia mepivacaine Mepivacaine 3% uterosacral ligament block Saline irrigation (sham procedure) Non-pharmacological

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years: To ensure that participants are legal adults and able to provide informed consent.
* Indication for office-based diagnostic hysteroscopy: The patient must be scheduled for a diagnostic hysteroscopy, either for uterine cavity evaluation or diagnostic purposes.
* Simple procedures like uterine polypectomies involving 1, 2, or more than 3 polyps or endometrial biopsy
* No previous hysteroscopies

Exclusion Criteria

* Age \< 18 years
* Known allergy to any local anesthetic
* General contraindications to hysteroscopy including pregnancy (established via interview, last menstrual period, contraceptive use, or pregnancy test), active infection (e.g., pyometra or recent pelvic inflammatory disease), recent uterine perforation, etc.
* Complex procedures like myomectomy with morcellator
* Failure to access the uterine cavity
* Anatomic conditions preventing cavity access
* Excessive procedure duration or fluid use (fluid deficit \> 1000 cc)
* Known uterine malformations
* Waiting times exceeding 60 minutes
* Use of analgesic medication prior to the procedure
* Major complications related to the procedure including uterine perforation, creation of a false passage, or significant bleeding requiring interventions beyond standard care.
* Incomplete delivery of informed consent or failure to complete the pre-procedure anxiety questionnaire.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Maimónides Biomedical Research Institute of Córdoba

OTHER

Sponsor Role lead

Responsible Party

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Paula Caballero

MD Obstetrics and Gynecology Reina Sofia Hospital

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jorge Garcia Fernandez, MD, Principal Investigator

Role: PRINCIPAL_INVESTIGATOR

MD Obstetrics and Gynecology Reina Sofia Hospital, Cordoba, Spain

Central Contacts

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Jorge Garcia Fernandez, MD, Principal Investigator

Role: CONTACT

+34 622595644

Paula Caballero, MD, Collaborator, Investigator

Role: CONTACT

+34 617798032

References

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Al-Sunaidi M, Tulandi T. A randomized trial comparing local intracervical and combined local and paracervical anesthesia in outpatient hysteroscopy. J Minim Invasive Gynecol. 2007 Mar-Apr;14(2):153-5. doi: 10.1016/j.jmig.2006.09.007.

Reference Type RESULT
PMID: 17368248 (View on PubMed)

Kokanali MK, Guzel AI, Ozer I, Topcu HO, Cavkaytar S, Doganay M. Pain experienced during and after office hysteroscopy with and without intracervical anesthesia. J Exp Ther Oncol. 2014;10(4):243-6.

Reference Type RESULT
PMID: 25509976 (View on PubMed)

Vercellini P, Colombo A, Mauro F, Oldani S, Bramante T, Crosignani PG. Paracervical anesthesia for outpatient hysteroscopy. Fertil Steril. 1994 Nov;62(5):1083-5.

Reference Type RESULT
PMID: 7646610 (View on PubMed)

Cooper NA, Khan KS, Clark TJ. Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis. BMJ. 2010 Mar 23;340:c1130. doi: 10.1136/bmj.c1130.

Reference Type RESULT
PMID: 20332307 (View on PubMed)

Ahmad G, Saluja S, O'Flynn H, Sorrentino A, Leach D, Watson A. Pain relief for outpatient hysteroscopy. Cochrane Database Syst Rev. 2017 Oct 5;(10)(10):CD007710. doi: 10.1002/14651858.CD007710.pub3.

Reference Type RESULT
PMID: 35611933 (View on PubMed)

De Silva PM, Carnegy A, Smith PP, Clark TJ. Local anaesthesia for office hysteroscopy: A systematic review & meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020 Sep;252:70-81. doi: 10.1016/j.ejogrb.2020.05.062. Epub 2020 Jun 2.

Reference Type RESULT
PMID: 32570188 (View on PubMed)

Huang L, Yu Q, Zhu Z, Huang P, Ding X, Ma X, Chen Y, Su D. The Current Situation of Anaesthesia for Hysteroscopy in Mainland China: A National Survey. J Pers Med. 2023 Sep 26;13(10):1436. doi: 10.3390/jpm13101436.

Reference Type RESULT
PMID: 37888047 (View on PubMed)

Nowak A, Chmaj-Wierzchowska K, Lach A, Malinger A, Wilczak M. Evaluation of Pain During Hysteroscopy Under Local Anesthesia, Including the Stages of the Procedure. J Clin Med. 2024 Nov 21;13(23):7030. doi: 10.3390/jcm13237030.

Reference Type RESULT
PMID: 39685488 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Informed Consent Form

View Document

Other Identifiers

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HARP

Identifier Type: -

Identifier Source: org_study_id

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