Local anaesthesia during endometrial ablation: a systematic review

Background 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.

Objectives To evaluate systematically the different local anaesthesia techniques in relation to pain perception during endometrial ablation.

Search strategy Medline and Embase were systematically searched and reference lists of selected articles were checked for missed publications.

Selection criteria All types of studies reporting the performance of endometrial ablation under local anaesthesia in ten or more women were included.

Data collection and analysis Data about the procedure, the protocol of local anaesthesia, the acceptability and side-effects were extracted.

Main results 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%).

Conclusion 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.