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Effect of topical xylocaine for pain relief during hysterosalpingography among infertile women in Zaria, Nigeria: A randomized controlled trial

Background/Aim: Hysterosalpingography (HSG) is a radiological procedure that is used to assess the patency of the female genital tract. It is a routine procedure for evaluating female factor infertility in our environment where the incidence of tubal factor infertility is high. It is associated with varying degrees of discomfort and pain. The study aimed at comparing the efficacy of topical analgesia to a placebo for providing pain relief in women undergoing HSG as workup for infertility. Subjects and Methods: The study was a double-blind, parallel group randomized controlled trial of 117 infertile women who had HSG at the Ahmadu Bello University Teaching Hospital, Zaria, from February to December 2019. The intervention group (n = 59) and the control (n = 58) had 15 ml of 2% xylocaine gel and 15 ml of K-Y jelly (placebo) applied directly on their uterine cervical lip, respectively. The primary outcome measure was the mean Visual Analog Scale (VAS) for pain perception on each group during HSG at the point of cervical manipulation and uterine filling with contrast. Results: The mean VAS scores for pain perception in the xylocaine group during cervical manipulation and uterine filling were 2.3 (0.24) and 3.5 (0.35), respectively, while the scores for the placebo group during cervical manipulation and uterine filling were 7.1 (1.8) and 5.5 (0.32), respectively. The observed difference was statistically significant (P ≤ 0.001). Conclusion: During HSG of infertile women in Zaria, Nigeria, the use of topical xylocaine on the uterine cervix was associated with decreased pain perception during cervical manipulation and uterine filling with contrast when compared to placebo. “Trial registry: Www.clinicaltrials.gov, Identifier NCT03802032.”