Analgesic efficacy of combined intrauterine lignocaine flushing and paracervical block in hysteroscopy guided endometrial biopsy - A randomized controlled trial

Diagnostic hysteroscopy is a minimally invasive technique in modern gynecological practice. It enables direct visualization of the uterine cavity, facilitating accurate evaluation and treatment of intrauterine pathologies in an outpatient setting. This procedure avoids the need for general anesthesia or hospitalization, enhancing patient comfort and reducing healthcare costs. Despite these benefits, pain remains a key concern in influencing patient compliance, procedural success, and satisfaction. Para cervical block (PCB) is the most common route of administration of local anesthetic agent in various gynecology procedures. There are other routes of lignocaine administration (lignocaine) apart from PCB, such as cervical infiltration, local spray onto cervix. Emerging evidence from the past decade supports the use of intrauterine 2% lignocaine flushing for pain relief in minor gynecology procedures. The concept behind intrauterine lignocaine instillation is that, there are different neuronal pathways supplying uterus and cervix which have synergistic effect. Autonomic nerve fibers arising from S2 to S4 roots and innervating the uterus in the base of broad ligament as the Frankenhauser plexus. The basis of paracervical block is to interrupt these dense plexuses. However, the uterus and cervix receive nerve supply from other sources as well. Sympathetic nerve fibers arising from T10 to L1 roots enters the uterus along the course of Uterine artery. So, combination of intrauterine lignocaine flushing and paracervical block can take care of both pathways. Hence, we aimed to study the analgesic efficacy of combination of intrauterine lignocaine flushing and PCB versus PCB alone in hysteroscopy guided biopsy