Paracervical block diminishes cramping associated with cryosurgery

Abstract

Background: The choice of treatment method for cervical intraepithelial neoplasia can be dictated by the lesion size, by comfort of the operator with the technique, by the cost of the procedure, and by patient comfort with the procedure. The purpose of this research was to compare the usual method of cryosurgery (no anesthetic block) with a method using a paracervical block to reduce the pain and cramping associated with cryosurgery.

Methods: A prospective trial was designed and conducted in a colposcopy clinic. Of the 85 women enrolled in the study, all were immediately given 550 mg of naproxen sodium orally; 40 received no block and 45 received a paracervical block before the cryosurgery procedure. After the procedure, a trained interviewer elicited pain and cramping scores using a visual analog scale. Chi-square, Fisher's exact test, Mann-Whitney U, Wilcoxon signed-ranks test, Friedman's two-way analysis of variance, and multivariate analysis of variance with covariates were used to analyze the data.

Results: Each part of the double-freeze cryosurgical procedure was ranked according to the participants' perceptions of pain and cramping. The cramping after the first freeze was significantly less for women receiving the paracervical block than for the women undergoing the usual procedure (z = -2.44, P = .014). Including the discomfort from the injection itself, the women who received a paracervical block perceived less cramping overall during cryosurgery than the women with no block (z = -2.35, P = .019). The paracervical block did not decrease the pain from cryosurgery according to the participants' rankings of perceived pain.

Conclusions: A paracervical block is effective in reducing the cramping from cryosurgery.