Local anaesthesia during endometrial ablation: a systematic review.

Abstract

Endometrial ablation has been widely implemented in the outpatient setting. Many different protocols of local anaesthesia during endometrial ablation are used and described. However, prospective studies to assess and evaluate these protocols appear to be scarce. To evaluate systematically the different local anaesthesia techniques in relation to pain perception during endometrial ablation. Medline and Embase were systematically searched and reference lists of selected articles were checked for missed publications. All types of studies reporting the performance of endometrial ablation under local anaesthesia in ten or more women were included. Data about the procedure, the protocol of local anaesthesia, the acceptability and side-effects were extracted. Twenty-five studies, involving 2013 women, were included. Applied anaesthesia techniques included intracervical, paracervical and intrauterine anaesthesia or a combination of these techniques. Women who received a combination of either intra- or paracervical anaesthesia and intrauterine injections reported significantly lower pain scores than those who received no local anaesthesia or intra- or paracervical anaesthesia alone (P = 0.000), but the quality of evidence is low. The acceptability of endometrial ablation under local anaesthesia was high (77-94%). Endometrial ablation under local anaesthesia is a safe, feasible and acceptable procedure. The combination of either intra- or paracervical anaesthesia with intrauterine injections seems to be promising, but has to be investigated more thoroughly. Systematic review of local anaesthesia techniques during endometrial ablation.