Cervical blockade reduces pain and bleeding during LEEP for HSIL in small RCT

OBJECTIVE: To compare the effectiveness of pain and bleeding control between general anesthesia alone and general anesthesia combined with cervical blockade during the loop electrosurgical excision procedure (LEEP). METHODS: This prospective, randomized, controlled, open-label, exploratory clinical trial included 40 patients diagnosed with high-grade squamous intraepithelial lesion (HSIL) by colposcopic biopsy. Patients were randomly assigned in a 1:1 ratio: the control group underwent LEEP under general anesthesia only (n = 20), and the study group received general anesthesia with additional local cervical anesthesia (n = 20). Intraoperative bleeding, pain scores, pathological specimen size, surgical margins, and postoperative complications were compared. RESULTS: Demographic data were similarly distributed. Smoking was significantly more prevalent in the control group ( p <.01). Preoperative cervical cytology, HPV DNA results, colposcopic biopsy results, and hemoglobin values were also comparable between the groups. Postoperative hemoglobin values, hemoglobin decrease, specimen size, surgical margin status, or hospital admissions after discharge were similar ( p >.05). However, postoperative pain scores and intraoperative sponge usage were significantly lower in the cervical blockade group ( p <.01). Subgroup analyses showed that smoking had no effect on bleeding rates as well as specimen sizes, which also did not affect bleeding rates and pain scores ( p >.05). CONCLUSIONS: Cervical blockade in LEEP performed under general anesthesia significantly reduces bleeding and pain. It does not influence blood transfusions, recovery, hospital readmissions or complications. Cervical blockade may enhance patient comfort and minimize intraoperative morbidity during LEEP. These preliminary findings require confirmation in larger, multicenter, preferably blinded trials.