The Effect of Topical Lidocaine Gel, Intrauterine Lidocaine Injection and Combination of these Two Methods for Relieving Pain during Curettage: A Double Blind Randomized Clinical Trial

Document Type : Original Article


1 Professor, Department of Anesthesiology, Kowsar Clinical Research Development Unit, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

2 Associate Professor, Department of Obstetrics and Gynecology, Kowsar Clinical Research Development Unit, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

3 Gynecologist, Kowsar Clinical Research Development Unit, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

4 General Practitioner, Student Research Committee, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

5 Researcher, Kowsar Clinical Research Development Unit, Facuty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.


Introduction: Curettage is one of the most common gynecological surgeries in women. Its complication is pain which increases dissatisfaction in patients. Therefore, it is necessary to find a way to treat this complication. This study was performed with aim to compare the effects of three methods of using lidocaine gel in the cervix, intrauterine injection of lidocaine, and a combination of two methods to reduce pain during curettage.
Methods: This clinical trial study was performed in 2017 on 120 patients candidates for curettage in Qazvin Kosar Hospital. Patients were randomly divided into three groups of topical lidocaine gel in the cervix, intrauterine injection of lidocaine and a combination of these two methods, and the drugs were prescribed before curettage. Vital signs and pain were recorded in patients and other information was collected by completing the questionnaire. Data analysis was performed using statistical software (version 22) and chi-square and ANOVA tests. P<0.05 was considered statistically significant.
Results: The intrauterine and intra cervical injection of lidocaine (0.3±0.72) and then injection of intra cervical lidocaine (0.45±0.84) alone significantly reduced pain during curettage in women (P=0.04). On the other hand, no severe hemodynamic changes were observed in these patients. No complications such as nausea and vomiting and no instability of vital signs were observed in any of the groups (P>0.05).
Conclusion: Intrauterine administration along with addition of topical lidocaine gel to the cervix can be used as a simple, low-cost, and safe method as to control pain during and after curettage.


  1. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics. 23nd New York: McGraw-Hill Education; 2014.
  2. Mirteimouri M, Bakhtiarizadeh T, Hadavi F. Comparison of cervical ripening with and without nitroglycerin before first trimester discharge abortion. Iran J Obstet Gynecol Infertil 2018; 21(5):1-5.
  3. Moreau C, Shankar M, Glasier A, Cameron S, Gemzell-Danielsson K. Abortion regulation in Europe in the era of COVID-19: a spectrum of policy responses. BMJ Sexual & Reproductive Health 2021; 47(4):e14-.
  4. Lannaman K, Romero R, Chaiworapongsa T, Kim YM, Korzeniewski SJ, Maymon E, et al. Fetal death: an extreme manifestation of maternal anti-fetal rejection. Journal of perinatal medicine 2017; 45(7):851-68.
  5. Guilbert ER, Hayden AS, Jones HE, White KO, Lichtenberg ES, Paul M, et al. First-trimester medical abortion practices in Canada: National survey. Canadian Family Physician 2016; 62(4):e201-8.
  6. Kakinuma T, Kakinuma K, Sakamoto Y, Kawarai Y, Saito K, Ihara M, et al. Safety and efficacy of manual vacuum suction compared with conventional dilatation and sharp curettage and electric vacuum aspiration in surgical treatment of miscarriage: a randomized controlled trial. BMC Pregnancy and Childbirth 2020; 20(1):1-5.
  7. Mamatha S, Lakshmikantha G. A comparative study between pipelle endometrial sampling and dilatation curettage in abnormal uterine bleeding. Intel J Clin Obstet Gynaecol 2020; 4(1):171-76.
  8. Udjung GI, Sirait RH. The Comparison of the Effectiveness of Paraservical Blocks with Intraservical Blocks on Pain Management in Dilated Abortus Inkompletus Curettage. Solid State Technology 2020; 63(5):5074-87.
  9. Rattanachaiyanont M, Leerasiri P, Indhavivadhana S. Effectiveness of intrauterine anesthesia for pain relief during fractional curettage. Obstetrics & Gynecology 2005; 106(3):533-9.
  10. Kerdtawee P, Wuttikonsammakit P, Chamnan P. Efficacy of Intravenous Sedation, Paracervical Block and Paracervical Block with Lidocaine Spray on Pain Relief during Uterine Curettage in First Trimester Incomplete Abortion: Randomized clinical trial. Thai Journal of Obstetrics and Gynaecology 2019: 139-48.
  11. Welch JL, Cooper DD. Should I use lidocaine with epinephrine in digital nerve blocks?. Annals of Emergency Medicine 2016; 68(6):756-7.
  12. Edelman A, Nichols MD, Leclair C, Astley S, Shy K, Jensen JT. Intrauterine lidocaine infusion for pain management in first-trimester abortions. Obstetrics & Gynecology 2004; 103(6):1267-72.
  13. Olad-Saheb-Madarek E, Ghojazaeh M, Behjati F, Alikhah H. The effect of different local anesthesia methods on pain relief in outpatient endometrial biopsy: randomized clinical trial. Journal of Caring Sciences 2013; 2(3):211.
  14. Yung SS, Lai SF, Lam MT, Lee VC, Li RH, Ho PC, et al. Randomized, controlled, double‐blind trial of topical lidocaine gel and intrauterine lidocaine infusion for pain relief during saline contrast sonohysterography. Ultrasound in Obstetrics & Gynecology 2016; 47(1):17-21.
  15. Aupongkaroon P, Srinil C, Sripipattanakul M, Tangsiriwatthana T. Comparison of Lidocaine Spray in Conjunction with Intrauterine Lidocaine versus Paracervical Block for Pain Relief in Fractional and Curettage: A randomized controlled trial. Thai Journal of Obstetrics and Gynaecology 2019: 180-6.
  16. Güney M, Oral B, Mungan T. Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy. International Journal of Gynecology & Obstetrics 2007; 97(2):125-8.
  17. Duangrudeesawat B, Srinil S. Lidocaine Prilocaine Cream in Conjunction with Paracervical Block versus Placebo with Paracervical Block for Pain Relief during Fractional Curettage. Thai J Obstet Gynaecol VOL 2022; 30(2).