A systematic review and meta-analysis of lidocaine spray efficacy in reducing pain in colposcopy-directed cervical biopsies.

OBJECTIVE

To evaluate the effectiveness of lidocaine spray in reducing pain during colposcopy-directed cervical biopsy (CDB) by reviewing evidence from published randomized controlled trials (RCTs).

METHODS

A search was conducted on PubMed and Google Scholar databases for RCTs investigating the use of lidocaine spray to manage pain during CDB. Pain scores during biopsy were the primary outcome, with secondary outcomes including pain during speculum insertion, endocervical curettage, and post-procedure. Risk of bias was evaluated, and standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated.

RESULTS

Four RCTs involving 812 patients were eligible for inclusion. Lidocaine spray significantly reduced pain during biopsy compared to comparator groups (SMD = -0.25, 95 % CI [-0.45, 0.04], p = 0.02, I2 = 57 %). Subgroup analyses showed significant pain reduction when lidocaine spray was compared with no anesthesia intervention (SMD = -0.20, 95 % CI [-0.39, -0.00], p = 0.04, I2 = 0 %) and forced coughing (SMD = -0.84, 95 % CI [-1.28, -0.40], p = 0.0002), but no significant difference was found when comparing lidocaine spray to placebo (SMD = -0.11, 95 % CI [-0.30, 0.08], p = 0.26, I2 = 0 %). Post-procedure pain was also significantly reduced (SMD = -0.26, 95 % CI [-0.41, -0.11], p = 0.0006, I2 = 0 %).

CONCLUSION

Lidocaine spray is an effective and safe option for pain management during CDB, particularly when compared to no anesthesia and forced coughing, however it is notable that it showed similar effectiveness when compared to placebo.