Lidocaine–prilocaine cream as analgesia for hysterosalpingography: a randomized, double blinded, controlled study Baldomero Arnau a, *, Esther Jovell b , Marino Romero a , Manuela Gonzalez c , Lola Esteba d , Araceli Garcia d a Department of Obstetrics and Gynaecology, Consorci Sanitari de Terrassa, Crta. Torrebonica s/n, 08227 Terrassa, Barcelona, Spain b Department of Epidemiology, Consorci Sanitari de Terrassa, Barcelona, Spain c Department of Pharmacy, Consorci Sanitari de Terrassa, Barcelona, Spain d Department of Radiology, Consorci Sanitari de Terrassa, Barcelona, Spain Introduction When EMLA, a 5% lidocaine 25 mg–prilocaine 25 mg/g cream (Astra Zeneca, Madrid, Spain) is applied to the genital mucosa, the most effective degree of anaesthesia was observed after 5–15 min compared to 1 h, when applied on the skin, while occlusive dressings were not necessary [1]. The quality of analgesia decreases with longer application times [1]. Van der Burght [2] investigated the duration of anaesthesia according to the time of application, verifying that the optimal time is between 5 and 10 min pre-intervention. Liberty [3], applying EMLA with a cervical cup 30 min before hysterosalpingography (HSG) significantly reduced pain during this procedure. Conversely, a Cochrane Review [4] concluded that there is little evidence of pain relief during the procedure and/or the first 30 min after HSG, and a recent meta-analysis [5] shows no European Journal of Obstetrics & Gynecology and Reproductive Biology 182 (2014) 216–219 A R T I C L E I N F O Article history: Received 9 June 2014 Received in revised form 19 September 2014 Accepted 22 September 2014 Keywords: Hysterosalpingography Anaesthetics Administration, Topical Pain Visual analog scale A B S T R A C T Objective: The efficacy of lidocaine–prilocaine cream (EMLA 1 ) analgesia in the practice of hysterosal- pingography is controversial. This study provides new drill results and a new method of application in terms of mode, time and place. The aim of the paper is to investigate the efficacy of 5% lidocaine 25 mg– prilocaine 25 mg/g cream applied to the uterine cervix for reducing pain during hysterosalpingography. Study design: A randomized, double blinded, controlled study set in the general gynaecology clinic of a university teaching hospital between September 2012 and June 2013. One hundred successive patients programmed to undergo hysterosalpingography were randomized to either 3 ml of EMLA (50) cream or 3 ml of placebo (50), placed endocervically and exocervically, 10 min before hysterosalpingography. Patients’ intensity of pain was assessed in four steps: at baseline (speculum application), after application of Pozzi tenaculum and cannula on the uterine cervix, during cervical traction and after contrast medium injection, using a 10-cm Visual Analogue Scale (VAS) immediately after the procedure. The most painful step was also identified. VAS was administered again at one-month follow-up visit. Trial registration: NCT01303614. Results: The contrast medium injection was the most painful step of hysterosalpingography in both groups (EMLA 3.96, placebo 4.54, 95%CI: À0.481 to 1.641). No differences were found between the two groups (P = 0.281) during this step. When comparing the VAS scale after the application of Pozzi tenaculum and cannula (EMLA 1.06, placebo 3.34, 95%CI: 1.495–3.065) and after cervical traction (EMLA 2.54, placebo 3.46, 95%CI: 0.034–1.806), significantly less pain was experienced by the EMLA group than the placebo group: P = 0.000 and P = 0.042, respectively. Conclusion: Endocervical and exocervical topical application of EMLA 10 min before performing hysterosalpingography significantly reduced pain during cervical manipulation with tenaculum and cannula and during cervical traction, but did not reduce pain during injection of contrast that was the most painful step. ß 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +34 937 310 007; fax: +34 937 003 633. E-mail addresses: barnau@cst.cat, ejovell@cst.cat (B. Arnau). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology jou r nal h o mep ag e: w ww .elsevier .co m /loc ate/ejo g rb http://dx.doi.org/10.1016/j.ejogrb.2014.09.035 0301-2115/ß 2014 Elsevier Ireland Ltd. All rights reserved.