Comparison of topical lidocaine spray with forced coughing in pain relief during colposcopic biopsy procedure: a randomised trial

Abstract

Our objective was to compare the effectiveness of local lidocaine spray (LS) compared to forced coughing (FC) for relieving the pain during colposcopically guided cervical biopsies (CGBs). The study was a randomised study, which included patients with abnormal cervical cytologic results requiring a colposcopic biopsy procedure. The patients were randomly assigned to either the 10% LS or the FC groups before the biopsy procedure. As a primary outcome, the pain was assessed by using a 10 cm visual analogue scale at the different steps during the procedure. Forty-four and 42 patients had CGBs using LS and FC, respectively. The age, parity, body mass index, history of previous curettage and vaginal delivery, smoking status and the number of biopsies were similar in both groups. The mean ± SD pain scores after the cervical biopsy were 3.25 ± 1.4 and 4.4 ± 1.3 in the LS and FC groups, respectively (p< .05). The operative time was longer in the LS than in the FC group (7.6 ± 1.4 vs. 5.2 ± 0.8, p: .004). No complication or adverse effect was observed in both groups. The present study showed that LS use can be recommended for pain relief during colposcopically directed cervical biopsy procedure with a superiority to the FC in the terms of pain and absence of any adverse reactions.

Impact Statement

• What is already known on this subject? A colposcopic-guided cervical biopsy is a painful procedure and different techniques have been proposed to relieve this pain with conflicting results. Studies have demonstrated that a forced coughing is a good and easy method for relieving pain with some disadvantages. Local lidocaine spray (LS) is another option for pain relief during the biopsy procedure. However, no randomised study has compared these two methods yet.

• What the results of this study add? The results from this randomised study suggest that LS has superiority in terms of pain relief during the colposcopic biopsy procedure and has no adverse reactions.

• What the implications are of these findings for clinical practice and/or further research? The evidence from different studies showed some conflicting results regarding the pain relief methods during the colposcopic biopsy procedure. The local LS can be used in this procedure in routine clinical practice. However, further studies with larger samples and comparison of different methods are needed.

Trial registration: ClinicalTrials.gov identifier: NCT03100565.

Keywords:

• Colposcopy
• pain
• forced coughing
• local lidocaine

Disclosure statement

The authors declare that they have no conflict of interest.