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Randomized comparative trial of cervical block protocols for pain management during hysteroscopic removal of polyps and myomas

Authors Lukes AS, Roy K, Presthus J, Diamond M, Berman J, Konsker

Received 18 June 2013

Accepted for publication 3 October 2013

Published 13 October 2015 Volume 2015:7 Pages 833—839

DOI https://doi.org/10.2147/IJWH.S50101

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Andrea S Lukes,1 Kelly H Roy,2 James B Presthus,3 Michael P Diamond,4 Jay M Berman,4 Kenneth A Konsker5

1Carolina Women’s Research and Wellness Center, Durham, NC, USA; 2Phoenix Gynecology Consultants, Phoenix, AZ, USA; 3Minnesota Gynecology and Surgery, Edina, MN, USA; 4Wayne State University, Detroit, MI, USA; 5Florida Woman Care, Boca Raton, FL, USA

Purpose: To evaluate the efficacy of two cervical block protocols for pain management during hysteroscopic removal of intrauterine polyps and myomas using the MyoSure® device.
Patients and methods: This was a randomized, comparative treatment trial conducted by five private Obstetrics and Gynecology practices in the USA. Forty premenopausal women aged 18 years and older were randomized to receive either a combination para/intracervical block protocol of 37 cc local anesthetic administered at six injections sites in association with the application of topic 1% lidocaine gel, or an intracervical block protocol of 22 cc local anesthetic administered at three injections sites without topical anesthetic, for pain management during hysteroscopic removal of intrauterine polyps and/or a single type 0 or type 1 submucosal myoma ≤3 cm. The main outcomes were a composite measure of procedure-related pain and pain during the postoperative recovery period, assessed by the Wong-Baker Faces Rating Scale (0= no pain to 10= maximum pain). The lesion characteristics, procedure time, and adverse events were summarized.
Results: A total of 17 polyps and eight myomas were removed in the para/intracervical block group, with diameters of 1.3±0.5 cm and 1.8±0.8 cm, respectively. In the intracervical block group, 25 polyps with a mean diameter of 1.2±0.7 cm and 7 myomas with a mean dia-meter of 1.9±0.9 cm were removed. The mean tissue resection time was 1.2±2.0 minutes and 1.2±1.4 minutes for the para/intracervical and intracervical block groups, respectively. The mean composite procedure-related pain score was low for both cervical block protocols, 1.3±1.4 in the para/intracervical block group vs 2.1±1.5 in the intracervical block group. During the postoperative recovery period, the mean pain scores were 0.3±0.7 vs 1.2±1.7 for the para/intracervical and intracervical block groups, respectively. There were no serious adverse events.
Conclusion: The MyoSure procedure for removal of polyps and myomas was well tolerated, with low pain scores reported for both the para/intracervical and intracervical block protocols.

Keywords: MyoSure, hysteroscopic morcellation, polypectomy, myomectomy

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