Paracervical block in office hysteroscopy with vaginoscopic approach to reduce patients’ pain perception: a propensity score matching analysis

BACKGROUND: Pain perception is a major limitation of office hysteroscopy and may lead to premature suspension of the procedure. Current guidelines do not routinely recommend local analgesia, and the effectiveness of paracervical block during office hysteroscopy performed with a vaginoscopic approach remains insufficiently investigated. OBJECTIVES: The primary objective was to assess whether paracervical block is associated with reduced pain perception during office hysteroscopy with a vaginoscopic approach. The secondary objective was to evaluate its impact on procedure suspension. MATERIALS AND METHODS: his retrospective observational cohort study included patients undergoing diagnostic and/or operative office hysteroscopy between January 2018 and January 2022. Paracervical block was administered without speculum or tenaculum. Confounders were addressed using multivariable regression and propensity score matching. RESULTS: A total of 2,028 patients were analyzed. In patients who did not receive PB, nulliparity was associated with severe pain (aOR 2.87, 95% CI 1.20-6.85) and procedure suspension (aOR 3.07, 95% CI 1.27-7.39), and cervical canal stenosis with markedly increased odds of both severe pain (aOR 23.17, 95% CI 10.44-51.40) and suspension (aOR 25.10, 95% CI 11.19-56.30). In patients receiving PB, nulliparity was no longer significantly associated with either outcome, and the effect of cervical canal stenosis was substantially attenuated (aOR 2.68, 95% CI 1.57-4.58 for severe pain; aOR 3.70, 95% CI 2.07-6.62 for suspension). CONCLUSION: Overall, in this large retrospective cohort, paracervical block performed through a vaginoscopic approach was associated with reduced pain perception and procedure suspension in selected patients.