Cervical blockade reduces pain and bleeding during LEEP for HSIL in small RCT

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Journal of lower genital tract disease Published April 8, 2026 Medically reviewed May 26, 2026 Study authors: Uysal Osman, Yalçin Yakup, Çakar Meltem Koç, Ozerkan Kemal PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider cervical blockade for LEEP may reduce pain and bleeding, but evidence is preliminary from a small trial.

This was a small, open-label, exploratory randomized controlled trial involving 40 patients diagnosed with high-grade squamous intraepithelial lesion (HSIL) by colposcopic biopsy. Patients were randomized to receive either general anesthesia only (n=20) or general anesthesia with additional local cervical anesthesia, or cervical blockade (n=20), during loop electrosurgical excision procedure (LEEP). The primary outcome was not explicitly stated.

The main results showed that the cervical blockade group had significantly lower postoperative pain scores (p<.01) and significantly lower intraoperative sponge usage (p<.01), suggesting reduced bleeding. However, the absolute numbers and effect sizes for these outcomes were not reported. There were no significant differences between groups for postoperative hemoglobin values, hemoglobin decrease, specimen size, surgical margin status, or hospital admissions after discharge (all p>.05).

Safety and tolerability data were not reported. Key limitations include the open-label design, exploratory nature, and very small sample size (n=40). The study was also conducted at a single center, and follow-up duration was not reported. The findings are preliminary and require confirmation in larger, multicenter, and preferably blinded trials. In practice, cervical blockade may be considered as an adjunct to enhance patient comfort and potentially reduce intraoperative bleeding during LEEP, but its routine use cannot be recommended based on this evidence alone.

Study Details

Study typeRct

Sample sizen = 20

EvidenceLevel 2

PublishedApr 2026

PMID41628600

View Original Abstract ↓

OBJECTIVE: To compare the effectiveness of pain and bleeding control between general anesthesia alone and general anesthesia combined with cervical blockade during the loop electrosurgical excision procedure (LEEP). METHODS: This prospective, randomized, controlled, open-label, exploratory clinical trial included 40 patients diagnosed with high-grade squamous intraepithelial lesion (HSIL) by colposcopic biopsy. Patients were randomly assigned in a 1:1 ratio: the control group underwent LEEP under general anesthesia only (n = 20), and the study group received general anesthesia with additional local cervical anesthesia (n = 20). Intraoperative bleeding, pain scores, pathological specimen size, surgical margins, and postoperative complications were compared. RESULTS: Demographic data were similarly distributed. Smoking was significantly more prevalent in the control group ( p <.01). Preoperative cervical cytology, HPV DNA results, colposcopic biopsy results, and hemoglobin values were also comparable between the groups. Postoperative hemoglobin values, hemoglobin decrease, specimen size, surgical margin status, or hospital admissions after discharge were similar ( p >.05). However, postoperative pain scores and intraoperative sponge usage were significantly lower in the cervical blockade group ( p <.01). Subgroup analyses showed that smoking had no effect on bleeding rates as well as specimen sizes, which also did not affect bleeding rates and pain scores ( p >.05). CONCLUSIONS: Cervical blockade in LEEP performed under general anesthesia significantly reduces bleeding and pain. It does not influence blood transfusions, recovery, hospital readmissions or complications. Cervical blockade may enhance patient comfort and minimize intraoperative morbidity during LEEP. These preliminary findings require confirmation in larger, multicenter, preferably blinded trials.