Feasibility of propofol–lidocaine anesthesia with paracervical block under preserved spontaneous breathing for day-case hysteroscopy

Abstract Day-case hysteroscopy requires an anesthetic approach that provides adequate procedural conditions while facilitating recovery. In this prospective single-arm pilot study, 60 women undergoing elective day-case hysteroscopy received intravenous propofol–lidocaine anesthesia combined with paracervical block while spontaneous breathing was maintained. The primary outcome was protocol success, defined as procedure completion without rescue opioid administration or escalation to advanced airway management or ventilatory support. Protocol success was achieved in 55/60 patients (91.7%; 95% CI, 82.0–96.6%). A post hoc sensitivity analysis using a stricter composite endpoint yielded a success rate of 71.7% (43/60; 95% CI, 59.2–81.5%). Five patients (8.3%) required rescue opioids for procedure-interfering movement. Respiratory depression occurred in 12/60 patients (20.0%). All experienced oxygen desaturation requiring jaw thrust and/or oropharyngeal airway insertion, and none required laryngeal mask airway placement or controlled ventilation. Two patients (3.3%) experienced transient tinnitus, with no confirmed local anesthetic systemic toxicity. Postoperative pain scores were low, but QoR-15 decreased by a median of 6 points at 24 h, with clinically meaningful deterioration in 25.0% of patients. The protocol appeared feasible in selected patients, but the single-arm design precludes conclusions regarding component-specific effects or comparative effectiveness. Randomized controlled trials are warranted. Trial registration: The trial was registered in the Chinese Clinical Trial Registry on February 3, 2026 (ChiCTR2600118213).