The results of the one-way sensitivity analyses show that the mucosal block dominated all analyses except 3, as seen in Table 4.
In the base case population, 27.5% of pain and cramping scores from cryosurgery for women with the mucosal block exceeded 98.5 mm.
Under these assumptions, the physician has the choice to use a block, and both the paracervical block and the mucosal block may reduce pain and cramping during the entire cryosurgery procedure.
The base case data led to the robust decision to use a mucosal block that will result, on average, in the lowest cost per averted pain and cramping.
This could more accurately direct the cost-effectiveness analysis for those instances where no block or a paracervical block may be more cost-effective, on average, than the mucosal block. But our model suggests that the mucosal block is amply robust to provide the least cost for the most pain and cramping averted.
Our analysis shows that a mucosal block is the most cost-effective method of averting the pain and cramping caused by cryosurgery in women who have taken an NSAID before the procedure.
Each woman in the treatment group received a mucosal block of 1.5 mL of 1% lidocaine with 1:100,000 epinephrine in each of four quadrants (12, 3, 6, and 9 o'clock), injected with a 27-gauge needle.
Eighty-seven women were enrolled in this study; 39 received no block and 48 received an anesthetic mucosal block. The two groups did not differ significantly in age, gravidity, parity, abortion history, method of payment, or usual amount of menstrual discomfort.
TABLE 1 Demographic, Clinical, and Histologic Characteristics of Participants in Cervical Mucosal Block Study (N=87) Participants Participants Who Received Who Received No Block Mucosal Block Characteristic (n=39) (n=48) Mean age, years (SD) 26.0 (7.0) 26.3 (7.2) Nulligravid, % 10.3 12.5 Nulliparous, % 20.5 16.7 One or more abortions, % 35.9 39.6 White, % 97.4 95.8 Mean menstrual cramping, VAS score (SD) 33.3 (34.8) 33.1 (32.8) Histologic confirmation, no.
This difference was eliminated in women with the mucosal block.
Significantly more women in the mucosal block group reported no pain or cramping (22.9%) than in the standard care group (2.6%) (Fisher's exact test, P [is less than] .001).
TABLE 3 Frequency of Pain and Cramping Occurrence, by Composite Score for Total Procedure No Block Mucosal Block no.