King's Mill anterior-posterior and transverse versus paracervical block in operative outpatient hysteroscopy: a randomised trial.

TL;DR

A randomized trial of 48 women compared the King's Mill AP and Transverse (KAPT) block with paracervical block (PCB) for pain control during operative outpatient hysteroscopy, finding KAPT superior with lower intra-procedural (median VAS 1 vs 2) and post-procedural pain (median VAS 0 vs 2).

Key findings

• KAPT block targets the Lee-Frankenhauser plexus in uterosacral ligaments where the highest density of uterine and cervical sensory fibres reside
• Intra-procedural pain was significantly lower with KAPT (median VAS 1) versus PCB (median VAS 2, p=0.040)
• Post-procedural pain at 10 minutes was significantly lower with KAPT (median VAS 0) versus PCB (median VAS 2, p=0.011)
• Both blocks achieved high patient satisfaction (100%) and safety profile with no serious adverse events reported

Why this matters at the bedside

For clinicians performing operative outpatient hysteroscopy, this trial provides evidence that anatomically targeted KAPT block achieves superior pain control compared to conventional PCB during both the procedure and immediate post-operative period, potentially improving patient experience and enabling expanded outpatient surgical capacity.