Paracervical anesthesia during hysteroscopy

Although the latest Cochrane review concluded that there was no evidence to support the usefulness of paracervical block, it is the most common modality used to manage pain at during in office hysteroscopy. Several papers have shown that the paracervical anesthesia produces an improvement in the perception of pain due to manipulation of the uterine cérvix during hysteroscopy. However, it does not seem to reduce the pain associated with the manipulation of the body / uterine fundus or fallopian tubes. The most commonly anesthetic used is lidocaine 1% with epinephrine, added vasoconstrictor decreases the absorption and increases the duration of action of the anesthetic, being effective as an anesthetic at 2 minutes after injection and lasting effect about 2-6 hours. Infiltration is usually done at the height of the uterosacral ligaments, about 3 mm deep and about 5 ml of anesthetic is injected