Global–local anaesthesia: combining paracervical block with intramyometrial prilocaine in the fundus significantly reduces patients' perception of pain during radio-frequency endometrial ablation (Novasure®) in an office setting
The aim of this study was to investigate the effectiveness of combining a paracervical block with an intramyometrial block of the uterine fundus on women's perception of pain during Novasure® radio-frequency impedance-controlled endometrial ablation. The study design was a case–control study. The study was conducted in private practice/office setting. The patients were 83 premenopausal women undergoing endometrial ablation due to heavy menstrual periods. The intervention used was hysteroscopic injection of local anaesthetic into the myometrium of the uterine fundus in addition to a paracervical block. There were no adverse events as a consequence of either the anaesthesia or the ablation procedure. All women were asked 60 s into the active ablation procedure to estimate their perception of pain on a scale from 0 to 10. Fifty-seven women (69%) scored a 0, and 77 (92%) scored 2 or less. None needed to use recovery room facilities after the procedure, and none made use of the access to performing surgeon the evening and night after the procedure. Combining a traditional paracervical block with a transhysteroscopic injection of local anaesthesia into the subendometrial myometrium of the fundus of the uterus significantly reduces women's perception of pain during radio-frequency impedance-controlled endometrial ablation.