This review combined nine randomized trials of 1,045 patients having outpatient hysteroscopy. It looked at instilling lidocaine into the uterus versus a placebo or rectal NSAIDs. The main focus was pain during the procedure.
The analysis found lidocaine significantly reduced pain during hysteroscope insertion and at 10 minutes after the procedure. Patient satisfaction was also higher with lidocaine. However, there was no significant difference in pain during uterine visualization, biopsy, or at 30 minutes post-procedure. The need for extra pain medicine showed a non-significant trend toward reduction.
The review reported no significant increase in adverse events compared to placebo. The main reason to be careful is that the pain relief is transient and does not cover all parts of the procedure. The evidence comes from a meta-analysis, which can be limited by differences between the included studies.
Readers should know that lidocaine may help with some specific moments of discomfort during hysteroscopy, but it is not a complete pain solution for the entire procedure.