Objective: The aim of the study was to determine whether an injection
of a local anesthetic is more painful than a cervical punch biopsy without
local anesthesia.
Materials and Methods: The study was a randomized controlled
trial, conducted at the Helsinki University Central Hospital. It consisted
of 204 women referred for colposcopic assessments. Half of them were
randomized to receive local anesthesia before their cervical punch biopsies.
After the injection of the local anesthetic, the cervical punch biopsy, and
the endocervical curettage, the women scored their actual pain using a
10-cm visual analog scale (VAS).
To measure the difference in VAS scores between two groups, a linear
regression model was used. Binomial regression model was applied
for comparing the probability of experiencing unbearable pain between
the groups. Applying modeling approach allowed also for proper adjustment
for other potential risk factors.
Results: The mean VAS score for the injection of the local anesthetic was
2.7, the VAS score for the cervical punch biopsy without local anesthesia
was 3.5, and the difference was 0.8 (p = .017; 95% CI = 0.1–1.5). The mean
VAS for the biopsy with local anesthesia was 0.8, which was significantly
lower than the mean VAS for the biopsy without local anesthesia (difference
= 2.7; p < .001; 95% CI = 2.2–3.3). The relative risk for experiencing
moderate or severe pain (VAS ≥ 5) was 0.6 (p = .03; 95% CI = 0.3–0.9) for
the injection of local anesthetic versus the biopsy without local anesthesia.
Conclusions: Injection of a local anesthetic for colposcopy is less painful
than biopsies without local anesthesia, and local anesthesia decreases the
pain perceived.