Background: Office hysteroscopy is an excellent tool for assessing the uterine cavity, with a very low rate of complication. Oral medicines, local anesthetics, or inhalation-conscious sedation could be used for pain management. Local anesthetics, lignocaine, and use during the office procedure are evident to improve patient satisfaction and increase pain tolerance levels. Objectives: The current study aims to compare the effectiveness of adding lignocaine 2% to the distension media versus paracervical block during office hysteroscopy in pain reduction, and also to compare the need for rescue analgesia, complications rate, and satisfaction of both patients and gynecologists. Patients and methods: A randomized controlled clinical trial was conducted at the Laparoscopy and Cytogenetic Unit of Zagazig University Hospital, between January 2020 and September 2022. A total of 240 women who were eligible for diagnostic hysteroscopy were randomly assigned either to Group 1 (lignocaine 2% mixed with saline distention media) or Group 2 (lignocaine 2% through the paracervical block). We compared pain scores before and after the procedure, patient satisfaction, and surgeons' satisfaction in each group. Results: Paracervical pain during cervical canal passage was greater in Group 2 than in Group 1.  However, there was no significant difference in pain levels between the 2 studied groups during the examination of the cavity and for the following 10 minutes. Group 1 had higher satisfied patients and surgeons compared to Group 2. Conclusion: When compared to a paracervical block, the use of lignocaine 2% with saline distension medium was more effective in managing pain without making the patients feel uncomfortable.