Objective: To estimate the effect of lidocaine-prilocaine cream on patient pain at the time of office pessary removal and reinsertion.
Methods: In this double-blind, randomized placebo-controlled trial, participants undergoing routine pessary care in a urogynecology office at a tertiary referral center were randomized to application of 4 g of either lidocaine-prilocaine or placebo cream 5 minutes before pessary change. Visual analog scale pain scores were collected from the patient at baseline, after pessary removal, and after pessary reinsertion. Physicians also recorded their estimate of patient pain at pessary removal and reinsertion. The primary outcome was the participant-reported visual analog scale pain score at the time of pessary removal and reinsertion. A sample size of 26 per group (n=52) was planned to estimate an absolute mean difference in visual analog scale pain of 2.1 cm at the time of pessary removal. An analysis of covariance was used to evaluate pain at removal and reinsertion as a function of treatment assignment controlling for baseline pain.
Results: From July 2015 through February 2016, 116 women were screened and 54 were recruited: 28 in the lidocaine-prilocaine cream group and 26 in the placebo group. One patient in the lidocaine-prilocaine cream group was later withdrawn owing to vaginal erosion. The participants were all postmenopausal women, with an average age of 77.8 years. Most characteristics were similar between groups. After adjusting for baseline pain, participants randomized to the lidocaine-prilocaine group had lower pain at pessary removal when compared with those assigned to placebo (mean difference=-2.05, 95% confidence interval -3.69 to -0.41; P=.015).
Conclusion: Lidocaine-prilocaine cream use at the time of office pessary removal reduces patient-reported pain. Clinicians may wish to include this simple intervention to optimize patient comfort and compliance.
Clinical Trial Registration: ClinicalTrials.gov, NCT02380742.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/AOG.0000000000002098 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Robot-Assisted Laparoscopic Sacrohysteropexy with Autologous Fascia Lata.
Int Urogynecol J
December 2024
Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia.
Introduction And Hypothesis: Autologous fascia lata has been increasingly utilised in pelvic floor reconstructive surgeries such as sacrocolpopexy and sacrohysteropexy. This case highlights sacrohysteropexy with autologous fascia lata as a promising option for women with advanced uterovaginal prolapse who wish to preserve their uterus and avoid synthetic mesh.
Methods: We report the case of a 65-year-old woman with stage 3 pelvic organ prolapse following one forceps and one spontaneous vaginal delivery.
Examining pessary use and satisfaction in managing pelvic organ prolapse: results from a cross-sectional multicentre patient survey.
BMC Urol
December 2024
College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Background: Vaginal pessaries are a common method of managing pelvic organ prolapse (POP), as well as different types of urinary incontinence, allowing patients to successfully improve overall quality of life. Yet despite their positive attributes, there are several reasons why patients may choose to discontinue using pessaries and proceed with surgery to treat their condition instead. This study aimed to explore patients' experiences of pessary use in treating POP.
View Article and Find Full Text PDFComplications in Pelvic Organ Prolapse With 3-Month Versus 6-Month Pessary Care: Pilot Study.
Urogynecology (Phila)
November 2024
From the Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil.
Article Synopsis
- The study investigates the safety and complications of vaginal pessary use for women with pelvic organ prolapse (POP) by comparing follow-up intervals of 3 months versus 6 months.
- In this randomized clinical trial, 38 women with advanced POP were divided into two groups to assess the impact of differing cleaning and monitoring frequencies by a healthcare professional.
- Results showed no significant difference in ulcerations between the groups, but the 6-month group had a higher incidence of bacterial vaginosis, suggesting more frequent follow-up may be beneficial.
Cervical cerclage vs cervical pessary in women with cervical insufficiency: A multicentric, open-label, randomised, controlled pilot trial [the CEPEIC trial].
Eur J Obstet Gynecol Reprod Biol X
December 2024
Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Objective: Cervical insufficiency accounts for 8 % of preterm births. Pessary and cerclage are considered preventive approaches for preterm birth. These interventions were compared in terms of reducing the prematurity rate in women with previous preterm birth, due to cervical insufficiency or due to having a short cervix in their current pregnancy.
View Article and Find Full Text PDFTopical lidocaine for pessary removal and reinsertion pain reduction: a randomized clinical trial.
Am J Obstet Gynecol
September 2024
Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL.
Article Synopsis
- Vaginal pessaries are a cost-effective, non-surgical option for treating pelvic organ prolapse and stress urinary incontinence, but their maintenance can cause pain.
- This study aimed to compare the pain-reducing effects of lidocaine HCl 2% jelly to those of standard lubricating jelly during pessary maintenance exams.
- Conducted as a randomized clinical trial with 66 female participants, the study measured pain levels using a visual analog scale, ultimately assessing if lidocaine HCl jelly provided better pain relief compared to lubricating jelly.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!