Pain Management During In-Office Gynecologic Procedures

Abstract

Gynecologic procedures performed in office are often done without anesthesia. Pain management is not often considered for women undergoing endometrial biopsies, Intrauterine device (IUD) placement, vaginal biopsies, or cervical biopsies. The purpose of this quality improvement (QI) project was to determine if EMLA cream, which is a combination of lidocaine and prilocaine, could be effectively incorporated into the practice for specific in-office procedures. Six cycles of Plan, Do, Study, Act (PDSA) were completed over a twelve-week period in a gynecologic oncology practice in eastern North Carolina, using EMLA applied to the biopsy site or to areas where discomfort from implementation was expected. Three out of four providers in the clinic reported satisfaction with the project results and wanted to incorporate the use of EMLA cream into the protocol for these specific procedures. Patient questionnaires showed a variety of results, but overall, improvements in pain and experience were reported. Results indicated that using EMLA cream for these specific procedures is an option for pain management in this clinic.