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Spray lidocaine blocks pain in LEEP procedure on cervix

NEW YORK (Reuters Health) – A spray form of lidocaine may be a good alternative to injected anesthetics for women having pre-cancerous tissue removed from the cervix.

A randomized controlled trial in Thailand has shown that the spray reduces pain during loop electrosurgical excision procedures (LEEP), although the study did not address the bleeding rate seen with the new formulation.

“One of the concerns that was not mentioned in the study was bleeding,” Dr. Diane Harper, an expert in HPV-associated diseases at the University of Missouri-Kansas City, told Reuters Health by email. “The standard use of lidocaine with epinephrine, or vasopressin, is to control the bleeding that comes with disrupting the epithelium. There can be substantial bleeding associated with LEEP.”

She added, however, that in terms of the study’s main endpoint — pain — it was “well-planned and executed.”

Dr. Harper was not associated with the study, which will appear online in the September issue of Obstetrics & Gynecology.

In the study, 51 patients were randomized to receive standard lidocaine injection and 50 were randomized to spray lidocaine, which has previously been used for minor procedures like intubation, endoscopy and tonsillectomy, but not for LEEP.

The groups were well-balanced with the exception of punch biopsy at the time of colposcopy, which was more than twice as common in the injection group (37.3% vs 16.0%; p=0.02).

Baseline pain scores were taken on a 10-cm visual analog scale and then retaken at three additional time points: post-anesthesia, excision, and 30 minutes post-excision.

Pain scores between the groups were not significantly different, with the exception of the post-anesthesia time point, when patients who had received the spray form had significantly less pain (injection, 3.4 vs spray, 0.6; p<0.01).

Patients’ satisfaction scores were similar in both groups (median score 8.5 for both groups, p=0.83).

The authors, led by Dr. Kittipat Charoenkwan of Chiang Mai University in Thailand, called the spray formulation of lidocaine “an effective and practical alternative” to the standard injectable form.

They do not, however suggest that it be a new standard first-line option.

One additional practical issue with using the lidocaine spray is that it requires a three-minute waiting time in order to take effect before the procedure can begin, the authors pointed out.

“Waiting three minutes for the topical lidocaine to work is truly ‘like a century’ to a woman who is bottom naked and has a speculum inside of her,” Dr. Harper said. She added that the three-minute wait would be required again if a patient needed additional anesthetic, whereas the injectable form requires no uptake time in order to take effect.

Dr. Charoenkwan did not respond to a request for comment.


Obstet Gynecol 2013.