Topical Anesthesia for Minor Gynecological Procedures: A Review

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Abstract
This article reviews the published literature for topical anesthetics that have been used for pain relief during minor gynecological procedures. EMLA (an eutectic mixture of the local anesthetics, lidocaine 2.5% and prilocaine 2.5%), which is the best-studied topical anesthetic, produces effective analgesia for superficial surgical procedures after application for 5 to 10 minutes and has been extensively studied in various procedures including removal of genital warts, vulval biopsy, laser treatment of CIN lesions, and hysteroscopy. EMLA is well tolerated and provides good pain relief for procedures involving the surface tissues such as removal of genital warts and hysteroscopy. For procedures involving deeper tissues, EMLA reduces the pain of local anesthetic injection. Other topical anesthetics, such as lidocaine gel and spray, benzocaine 20% gel, mepivacaine solution, tetracaine solution, and cocaine spray, have been less extensively studied in these indications, and benefits seem to be limited. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to list the various topical anesthetics studied for use in minor gynecologic procedures and to identify the efficacy of each solution in providing analgesia for minor gynecologic procedures.