Jessie Wetherbe, DNP, MSN, FNP-BC, M.C., M.Ed.

Abstract:

Background: Endometrial biopsy is a common office-based procedure in gynecologic care, often associated with significant pain and discomfort. Despite the availability of various pain management strategies, many patients undergo the procedure with minimal or no analgesia. Objectives: This quality improvement project evaluates the effectiveness of 2% lidocaine gel in reducing pain during endometrial biopsy compared to standard care. Methods: This project employed a pre- and post-intervention design in an urban OBGYN practice serving a diverse and vulnerable population. Eligible participants were adult women scheduled for EMB as part of their diagnostic evaluation. Patients were excluded if they had contraindications to lidocaine or if they had pain due to another etiology. In the pre-intervention phase, patients underwent biopsy using the standard protocol (without local anesthesia). In the intervention phase, participants received 2% lidocaine gel applied to the cervix 10 minutes before the procedure. Pain scores were collected using a 10-point visual analog scale (VAS) immediately after, 5 minutes, and 10 minutes post-procedure. Results: A total of 26 participants were included in this quality improvement project: 15 in the control group and 11 in the intervention group. Independent t-tests showed that pain scores were significantly lower in the lidocaine group immediately after the procedure (t(24) = 4.183, p < .001) and at 5 minutes post-procedure (t(24) = 2.187, p = .019). No significant difference was found at 10 minutes (p = .128). Univariate analysis controlling for age confirmed that the reduction in immediate post-procedure pain remained significant (F(1,23) = 11.671, p = .020). There were no significant differences between groups in the use of misoprostol (p = 0.31) or NSAIDs (p = 0.42). Conclusion: Topical lidocaine is a simple and cost-effective intervention to improve patient comfort during endometrial biopsy. Implementing this pain management strategy may enhance patient satisfaction and procedural tolerability, particularly in underserved populations with limited access to alternative analgesia. Further studies with larger sample sizes are recommended to validate findings and optimize clinical guidelines.

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