![]() Non steroidal anti-inflammatory drugs (NSAIDs) show their effect by cyclooxygenase inhibition, thereby decrease the release of prostaglandins and do not discriminate between the two enzymes cyclooxygenase (COX)-1 and -2 9. The addition of 10 per cent lidocaine spray to a paracervical block safely decreased perceived pain during first-trimester surgical abortion, as compared to paracervical block alone 8. Lidocaine spray produces significant pain relief even in the absence of clinically significant serum levels as it is proposed to act by reduction of generation and conduction of peripheral pain impulses in dysfunctional or damaged nociceptors situated directly below the application site 2. The authors advocated the use of lidocaine spray as the first choice analgesic and pethidine as the second choice analgesic in the fractional curettage procedure. All analgesic procedures were significantly effective for reducing pain in post operative period. Though significant pain reduction was achieved for both intra- and postoperative periods by using analgesics but lidocaine spray was the best choice for reducing pain score during curettage procedure. A total of 144 mutiparous women were randomly allocated to the six groups. The study of Acmaz and colleagues 7 assessed the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, pethidine and diclofenac sodium on fractional curettage procedure. In most studies pain score was more than six during the procedure when using placebo implying the need of pain relief 6. ![]() There was no evidence that paracervical block reduced pain compared to alternative regional anaesthetic methods or systemic analgesics and sedatives. Tangsiriwatthana et al 6 assessed the efficacy of paracervical block for cervical dilatation and uterine intervention, and stated that no local anaesthetic agent prevented pain as well as general anaesthesia. Paracervical block is a convenient, safe, simple, and effective anaesthetic technique for curettage being used by most clinicians with or without additional analgesia. Most commonly used agent is one per cent lignocaine injected at 5 and 7 O’clock position on the cervix. Paracervical anaesthetics block transmission of pain through sympathetic and parasympathetic sensory fibres, before these fibres enter the uterus at the level of the internal cervical os 6. The paracervical block with local anaesthetic agents is one of the most common procedures used since 1925 6. ![]() Lichtenberg et al 5 showed that only 10 per cent of clinics use general anaesthesia, so local anaesthesia becomes a dominant method with 58 per cent use in clinics and 32 per cent use of intravenous sedation with local anaesthesia. General anaesthesia provides analgesia, amnesia and a hypnotic effect and provides adequate operating conditions for cervical dilatation and uterine intervention but it is associated with increased mortality and morbidity. Other factors are related to the patient's and physician's preferences. The choice of anaesthesia and analgesia is dependent on effectiveness, cost, safety, and side effects. ![]() Pain on VAS more than six suggests the need of pain relief. Endometrial biopsies have shown VAS scores ranging from five to seven 3, 4. Most patients can tolerate pain to complete necessary procedures but studies show that pain scores with cervical biopsy and cervical curettage range from four to six on a 10-point visual analogue scale (VAS) 1, 2. Patients frequently experience moderate to severe pain during these gynaecologic procedures and in some cases the severity of pain makes it impossible to take adequate sample in biopsy. The major limitation in successful completion of the procedure is pain management. Other minor procedure which can be conducted in outpatients settings are suction termination, cervical biopsy, saline infusion sonography, etc. The D&C has been substituted by outpatient procedures like endometrial suction curette biopsy, aspiration by Karman's cannula or fractional curettage or hysteroscopically guided biopsy. Common gynaecological problem as abnormal uterine bleeding and postmenopausal bleeding require evaluation by sampling of the endometrial tissue which was initially done by dilatation and curettage (D&C).
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