A double-blind, randomized, placebo-controlled trial of prilocaine and felypressin (Citanest and Octapressin) for the relief of pain associated with cervical biopsy and treatment with the Semm coagulator

Abstract

Objective: To quantify the anticipated and actual pain experienced in association with preliminary cervical punch biopsies and subsequent ablative treatment with the Semm coagulator, and to test the hypothesis that the intracervical injection of prilocaine with felypressin reduces the intensity of the pain experienced.

Materials and methods: One hundred consecutive women referred with abnormal cervical smears for colposcopic assessment and considered suitable for treatment with the Semm coagulator were recruited to a double-blind, randomized, prospective, placebo-controlled trial conducted in a colposcopy clinic in a university teaching hospital. Personal particulars were taken and anticipated pain scored. The patients were injected with randomized externally identical vials of prilocaine and felypressin (Citanest and Octapressin) or placebo. After biopsy and treatment, patients scored their actual pain experienced. Pain scores were compared as the main outcome measure. Relative risks with 95% CIs were calculated and compared using the CI Analysis computer programme (Professor Martin J Gardner and the British Medical Journal Version 1.1, copyright 1991).

Results: Anticipated pain was greater than the actual pain experienced in both groups. Women receiving the local anesthesia experienced a significantly greater reduction in pain (p < .05) with only 4.3% and 6.7% experiencing moderate pain during biopsy and treatment, respectively. The active drug abolished severe pain. In the placebo group, 44.7% felt mild pain at the most.

Conclusions: Intracervical injection of prilocaine and felypressin reduces the intensity of pain experienced in women undergoing cervical biopsy and treatment with the Semm coagulator. Its use is commendable but is not absolutely necessary in all cases.