Oral NSAID, lidocaine equally effective for fractional curettage-associated pain, but combination may be more effective in postmenopausal women

The oral nonsteroidal anti-inflammatory drug dexketoprofen (approved for use in the United Kingdom) given preoperatively and intrauterine lidocaine work equally well to relieve the pain associated with fractional curettage. Combining the 2 drugs offers no additional advantage in pain relief over either alone, according to a study conducted in Turkey.

In the double-blind study, researchers randomized 111 women scheduled for fractional curettage for abnormal uterine bleeding to 1 of 4 treatment arms: dexketoprofen and lidocaine, placebo and lidocaine, dexketoprofen and saline, or placebo and saline. Dexketoprofen was given at a dose of 25 mg 30 minutes before the procedure. Lidocaine 2% was given as 5 mL and introduced into the uterine cavity 3 minutes before fractional curettage. Patients were asked to rate their pain on a 0 (no pain) to 10 (worst pain) visual analog scale before, during, and 30 minutes after the procedure. Pain scores were consistent among the groups at baseline.

Compared to the placebo/saline group, pain scores during the procedure were lower by 42% in patients randomized to dexketoprofen/lidocaine, 41% lower in women randomized to lidocaine alone, and 53.8% lower in those assigned to dexketoprofen alone, with all differences (compared to placebo/saline) being statistically significant (P<.001).

Researchers speculated that cervical stenosis and genital atrophy may be responsible for higher degrees of pain during fractional curettage in postmenopausal women, who had pain relief from the combination of dexketoprofen and lidocaine but not either as monotherapy.

Api O, Ergen B, Api M, Ugurel V, Emeksiz MB, Unal O. Comparison of oral nonsteroidal analgesic and intrauterine local anesthetic for pain relief in uterine fractional curettage: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol. 2010;203(1):28.e1-e7.