# APBA Kısa Özet

Operative outpatient hysteroscopy is limited by procedural pain. In a single‑centre, participant‑ and outcome‑assessor‑blinded randomised trial at King's Mill, the novel Anterior‑Posterior and Transverse (KAPT) block was compared with the standard paracervical block (PCB) in 48 women. The KAPT block produced significantly lower intra‑procedural and 10‑minute post‑procedural pain, both co‑primary endpoints reaching statistical significance. Patient satisfaction was 100% in both arms and no serious adverse events occurred.

# Çalışma neyi araştırdı?

The investigators sought to determine whether the KAPT block, which targets the Lee‑Frankenhauser plexus within the uterosacral ligament complex, offers superior analgesia to the conventional PCB during operative outpatient hysteroscopy. Pain control is a recognised barrier to wider use of office‑based hysteroscopic surgery, and previous studies of PCB have shown variable efficacy. By delivering local anaesthetic directly to the region of highest sensory fibre density, the KAPT technique was hypothesised to reduce pain both during the procedure and in the immediate recovery period.

# Yöntem

A single‑centre, randomised controlled trial was conducted in a UK district general hospital. Forty‑eight eligible women were randomised 1:1 to receive either the KAPT block or the PCB, each using 10 ml of prilocaine. Randomisation was concealed, and participants as well as outcome assessors were blinded; the clinicians administering the blocks were not, which could introduce performance bias. Pain was measured on a 10‑point Visual Analogue Scale (VAS) at three time points: during the hysteroscopic procedure (intra‑procedural), 10 minutes after completion, and during cervical dilatation (exploratory). Analyses followed an intention‑to‑treat principle, employing the Mann‑Whitney U test, Hodges‑Lehmann median differences, and percentile bootstrap 95 % confidence intervals. A hierarchical fixed‑sequence testing strategy protected the overall type‑I error rate for the two co‑primary endpoints.

# Temel bulgular

The KAPT block yielded a median intra‑procedural VAS of 1 (IQR 0‑3) versus 2 (IQR 1‑6) for PCB, giving a Hodges‑Lehmann median difference of –1.00 (95 % CI –3.00 to 0.00; p = 0.040). At 10 minutes post‑procedure, median VAS was 0 (IQR 0‑1.25) with KAPT compared with 2 (IQR 0‑3.25) for PCB (median difference –1.00, 95 % CI –2.00 to 0.00; p = 0.011). Both co‑primary outcomes therefore reached significance under the hierarchical testing plan. Cervical dilatation pain did not differ significantly between groups (p = 0.146). No serious adverse events were reported, and patient‑reported satisfaction was 100 % in each arm.

# Bulgular ne anlama geliyor?

These results indicate that targeting the uterosacral ligament complex with the KAPT block provides clinically meaningful analgesia during operative hysteroscopy. The median reduction of one VAS point, while modest in absolute terms, was statistically robust and occurred without any increase in adverse events. The identical satisfaction rates suggest that patients perceived the analgesic benefit as sufficient to meet their expectations for comfort. The lack of difference in cervical dilatation pain may reflect that this component of discomfort is mediated by additional neural pathways not addressed by either block.

# Klinik önem

The KAPT block could be incorporated into office‑based hysteroscopic services to improve patient comfort, potentially expanding the feasibility of same‑day procedures and reducing the need for additional analgesic medication. Its safety profile—no serious adverse events and full patient satisfaction—supports adoption in settings where skilled clinicians can perform the block. Nevertheless, the single‑centre nature of the trial and the modest sample size mean that larger, multicentre studies are required to confirm reproducibility, assess cost‑effectiveness, and explore longer‑term outcomes such as return to normal activity.

# Sınırlılıklar

Key limitations include the single‑centre design, which may limit external validity, and the small sample size of 48 participants, reducing statistical power and precision of effect estimates. Blinding was limited to participants and outcome assessors; staff delivering the blocks were aware of allocation, introducing possible performance bias. The trial was not preregistered, raising the risk of selective outcome reporting. Confidence intervals around median differences were relatively wide, reflecting imprecision. Finally, the exploratory cervical dilatation endpoint did not show benefit, and the study did not assess pain beyond the 10‑minute post‑procedure window, leaving longer‑term comfort unexamined.