Based on two small trials, there was no significant difference in pain relief in women receiving oral analgesics compared with placebo or no treatment (129 women; MD -3.51; 95% CI -10.03 to 3.01). We consider this evidence to be of a low to moderate quality. In routine clinical practice, intracervical injection of local anaesthetic with a vasoconstrictor (lignocaine plus adrenaline or prilocaine plus felypressin) appears to be the optimum analgesia for treatment. However, further high-quality, adequately powered trials should be undertaken in order to provide the data necessary to estimate the efficacy of oral analgesics, the optimal route of administration and dose of local anaesthetics.
A randomized trial of the use of cocaine spray to provide pain relief during laser vaporization of the cervix.
In a double-blind trial, 50 patients undergoing laser vaporization of the cervix for cervical intraepithelial neoplasia were randomly allocated to one of two groups. One group had the cervix sprayed with 3-4 ml of a solution containing 10% cocaine, the other a placebo solution during the laser treatment. Women in the cocaine group had significantly less pain as assessed by a visual analogue scale (P less than 0.001) and by a verbal rating scale (P = 0.002). The cocaine group also had less blood loss (P = 0.001) as assessed subjectively by the operator.