The aim of the present study was to investigate whether the addition of a paracervical block to local intrauterine anaesthesia or the use of an intramuscular non-steroidal anti-inflammatory drug was effective for pain control during and at 30 min after hysterosalpingography (HSG). A total of 120 patients undergoing hysterosalpingography were randomised into four groups. Patients received intramuscular dexketoprofen trometamol with or without a paracervical block or intracavitary lidocaine instillation with or without paracervical block. The primary outcome was the overall pain score from the four stages of the procedure. The lowest pain scores were observed in the patients receiving dexketoprofen trometamol with a paracervical block, whereas the highest pain scores were observed in patients with intracavitary lidocaine instillation without a paracervical block (p = 0.021). No beneficial effect was found when a paracervical block (PCB) was added to either systemic or local analgesics. The combination of intramuscular dexketoprofen and a paracervical block with plain lidocaine produced the best pain relief during the three specified steps and at up to 30 min after the HSG procedure.