REPRODUCTIVE MEDICINE Pain relief during hysterosalpingography: role of intracervical block Meenakshi B. Chauhan • Pinkey Lakra • Dehlan Jyotsna • Smiti Nanda • Vani Malhotra Received: 1 November 2011 / Accepted: 2 August 2012 / Published online: 28 August 2012 Ó Springer-Verlag 2012 Abstract Purpose Hysterosalpingography (HSG) is an important tool for evaluation of tubal factors in infertility. It does not require anesthesia but can be a painful procedure. Thus, this study was undertaken to establish the role of intra- cervical block as pain relief modality for HSG. Methods This prospective, randomized study included hundred women attending the Department of Obstetrics and Gynecology, at a tertiary care centre in India. They were divided randomly through a computer generated table into two groups of 50 women each. In the study group, women received intracervical block along with premedi- cation whereas in the control group women received pre- medication alone. Each patient was asked to rate her pain at six different points of time (T1–T6) during HSG using Visual analogue scale (VAS) and Verbal descriptive score. The difference in pain scores amongst the two groups was analyzed using independent t test. Results Reduction of pain was observed from placement of tenaculum till end of procedure (T3–T6) with intracer- vical block (p \ 0.05). Pain remained at a statistically lower level during the most painful steps i.e. traction of the cervix (VAS: 2.080.49 cm, 95 % C I 1.18–2.98 vs. 4.21.15 cm, 95 % CI 3.3–5.1, p = 0.001) and with the insertion of dye (VAS: 2.640.49, 95 % CI 1.7–3.5 vs. 5.121.45. 95 % CI 4.3–6.0, p = 0.001) in the study group as compared to control group. Conclusion Intracervical block can be offered to all women undergoing HSG to make the procedure less painful and thus improve the compliance. Keywords Hysterosalpingography Á Intracervical block Á Visual analog scale Á Verbal descriptive score Introduction Infertility is a worldwide issue in reproductive health. Tubal factors alone account for 14 % of causes of infer- tility, so it becomes mandatory to investigate for tubal patency [1]. Hysterosalpingography (HSG) is an important tool for this purpose. Due to its reliability and cost-effec- tiveness, it is the most commonly used method for evalu- ation of anatomy and patency of the uterus and fallopian tubes [2, 3]. As HSG usually does not require any cervical dilatation, it is done on outdoor basis. It does not require anesthesia but can be a painful procedure. Up to 72 % of women complain of significant discomfort with this test [4]. The pain can be due to cervical irritation, secondary to uterine distension with contrast media and due to peritoneal irri- tation as a result of contrast spill into the peritoneal cavity [5]. Various surveys and studies have been carried out in different countries regarding pain relief in HSG but there appears no consensus in terms of the type and the timing of administration of analgesia and anesthesia [6–9]. The use of paracervical block had been shown to decrease pain associated with therapeutic abortion, endometrial biopsy and office hysteroscopy [10, 11]. Favorable results of paracervical block as an anesthesia have been documented for outpatient gynecological procedures, and labor anal- gesia [10, 12, 13]. Thus, we hypothesized that intracervical M. B. Chauhan (&) Á P. Lakra Á D. Jyotsna Á S. Nanda Á V. Malhotra Department of Obstetrics and Gynecology, PG Institute of Medical Sciences, 15/8 FM, Medical Enclave, Rohtak, Haryana 124001, India e-mail: mbc51490@yahoo.co.in 123 Arch Gynecol Obstet (2013) 287:155–159 DOI 10.1007/s00404-012-2515-z