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Huang L, Yu Q, Zhu Z, Huang P, Ding X, Ma X, Chen Y, Su D. The Current Situation of Anaesthesia for Hysteroscopy in Mainland China: A National Survey. J Pers Med 2023; 13:1436. [PMID: 37888047 PMCID: PMC10608545 DOI: 10.3390/jpm13101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023] Open
Abstract
Purpose: The need for anaesthesia or analgesia for performing hysteroscopy remains debatable. This study aimed to conduct an overview of the situation of anaesthesia for hysteroscopy in mainland China. Methods: Two questionnaires were separately designed for anaesthesiologists and gynaecologists and distributed to every medical institution that performed hysteroscopic procedures on patients with infertility in mainland China. Electronic questionnaires were distributed via WeChat, and data on anaesthesia regimen, monitoring parameters, procedure number, and other information were collected. Results: Reproductive technology is conducted by 536 institutions in mainland China. The survey received 491 responses from anaesthetists (91.6%) and 436 from gynaecologists (81.3%). In 2021, 552,225 hysteroscopies were conducted in 268 medical centres. The average percentage of hysteroscopy under anaesthesia is 63.8% in 2021, wherein 47.3% of institutions have an anaesthesia percentage of >75%. Propofol and opioid analgesics, such as fentanyl and sufentanil, were the most commonly used intravenous anaesthetics. All sedations were performed by anaesthesiologists. Monitoring parameters included pulse oxygen saturation (98.9%), electrocardiogram (91.6%) and noninvasive blood pressure (91.3%). An anaesthesiologist-to-operating room ratio of <1 was observed in 31.3% of medical institutions. Surprisingly, 52.4% of medical institutions performing hysteroscopy had no postanaesthesia care unit (PACU). Most institutions with PACU were equipped with independent oxygen sources, suction and monitors. Both rigid and flexible hysteroscopes (rigid hysteroscope, 45.1%; flexible hysteroscope, 4.5%; both types, 50.4%) were used, and the hysteroscopic diameter was ≤5 mm in 60.3% of medical centres. Conclusions: China performs a large number of hysteroscopies, and sedation is the most frequently used anesthesia regimen. However, issues such as inadequate emergency support devices, insufficient personnel and weak resuscitation management after anaesthesia, have been observed.
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Affiliation(s)
| | | | | | | | | | | | | | - Diansan Su
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China; (L.H.); (Q.Y.); (Z.Z.); (P.H.); (X.D.); (X.M.); (Y.C.)
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Sharma S, Roy KK, Rai R, Zangmo R, Malhotra N, Das A. Assessment of Pain at Different Steps of Diagnostic Hysteroscopy Using Room Temperature Normal Saline versus Warmed Normal Saline Solution as Distension Medium: A Randomized Controlled Trial. Gynecol Minim Invasive Ther 2022; 11:41-46. [PMID: 35310129 PMCID: PMC8926041 DOI: 10.4103/gmit.gmit_5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/19/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives Compare pain intensity at entry into the cervical os, during uterine distension and 15 min after the procedure, in patients undergoing diagnostic hysteroscopy with room temperature normal saline versus that with saline warmed to 38-40°C, using visual analog scale (VAS) score. Furthermore, compare the time taken and failed procedures between them. Materials and Methods This was a randomized controlled, prospective study conducted at a Tertiary Care Center on 100 patients planned for diagnostic hysteroscopy with a 4 mm 30° hysteroscope using vaginoscopy technique. They were divided into two groups of 50 each, with control undergoing the procedure using normal saline at room temperature and the test with saline warmed to 38-40°C as distension medium. Primary outcomes were VAS at the point of entry into the internal os (T0), 1 min later (T1), and 15 min after the procedure (T15). Secondary outcomes were procedural acceptance, time taken, and failed procedures. Results The mean VAS in the control group at T0, T1, T15 was 3.31 (1.461;‒0.870-0.245), 2.46 (1.398;‒0.539-0.498), 0.75 (0.911;‒0.379-0.338), respectively, as compared to the test group of 3.62 (1.282;‒0.870-0.245), 2.48 (1.148;‒0.540-0.498), 0.77 (0.911;‒0.379-0.379), respectively. About 73.5% of controls and 68.8% in the test group were willing to undergo the procedure again. About 93.9% of controls would recommend it further as against 93.8% among the test controls. The time taken and number of failed procedures showed no statistical difference. Conclusion No significant difference was noted in terms of outcomes measured by warming the distension medium.
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Affiliation(s)
- Shikha Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Kallol Kumar Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakhi Rai
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rinchen Zangmo
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Anamika Das
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Peng X, Zhao Y, Xiao Y, Zhan L, Wang H. Effect of intravenous lidocaine on short-term pain after hysteroscopy: a randomized clinical trial. Braz J Anesthesiol 2021; 71:352-357. [PMID: 34229861 PMCID: PMC9373697 DOI: 10.1016/j.bjane.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 11/01/2020] [Indexed: 11/06/2022] Open
Abstract
Background The role of intravenous lidocaine infusion in endoscopic surgery has been previously evaluated for pain relief and recovery. Recently, it has been shown to reduce postoperative pain and opioid in patients undergoing endoscopic submucosal dissection. Similar to endoscopic submucosal dissection, operative hysteroscopy is also an endoscopic surgical procedure within natural lumens. The present study was a randomized clinical trial in which we evaluated whether intravenous lidocaine infusion would reduce postoperative pain in patients undergoing hysteroscopic surgery. Objective To evaluate whether intravenous lidocaine infusion could reduce postoperative pain in patients undergoing operative hysteroscopy. Methods Eighty-five patients scheduled to undergo elective hysteroscopy were randomized to receive either an intravenous bolus of lidocaine 1.5 mg.kg-1 over 3 minutes, followed by continuous infusion at a rate of 2 mg.kg-1. h-1 during surgery, or 0.9% normal saline solution at the same rate. The primary outcome was to evaluate postoperative pain by Visual Analog Scale (VAS). Secondary outcomes included remifentanil and propofol consumption. Results In the lidocaine group, the VAS was significantly lower at 0.5 hour (p = 0.008) and 4 hours (p = 0.020). Patients in the lidocaine group required less remifentanil than patients in the control group (p < 0.001). However, there was no difference between the two groups in the propofol consumption. The incidence of throat pain was significantly lower in the lidocaine group (p = 0.019). No adverse events associated with lidocaine infusion were discovered. Conclusion Intravenous lidocaine infusion as an adjuvant reduces short-term postoperative pain in patients undergoing operative hysteroscopy.
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Affiliation(s)
- Xuan Peng
- Renmin Hospital of Wuhan University, Department of Anesthesiology, Hubei, China
| | - Yuzi Zhao
- Renmin Hospital of Wuhan University, Department of Obstetrics and Gynecology, Hubei, China
| | - Yeda Xiao
- Renmin Hospital of Wuhan University, Department of Anesthesiology, Hubei, China
| | - Liying Zhan
- Renmin Hospital of Wuhan University, Department of Anesthesiology, Hubei, China
| | - Huaxin Wang
- Renmin Hospital of Wuhan University, Department of Anesthesiology, Hubei, China.
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Lee J, Lee S, Lee H, Kim HC, Park C, Kim JY. The effect of preoperative intravenous lidocaine on postoperative pain following hysteroscopy: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e22751. [PMID: 33080740 PMCID: PMC7571958 DOI: 10.1097/md.0000000000022751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of hysteroscopy for the diagnosis and treatment of uterine and endometrial abnormalities is often associated with postoperative pain. This randomized controlled trial aimed to assess the efficacy of preoperative intravenous (IV) lidocaine in reducing pain after hysteroscopy. METHODS In total, 138 patients undergoing elective hysteroscopy at the CHA Bundang Medical Center, Seongnam, Korea were randomly assigned to a control group (n = 69) or a lidocaine group (n = 69), which received normal saline or IV lidocaine at 1.5 mg/kg, respectively. The primary outcome was the incidence of postoperative pain. RESULTS The incidence of pain was significantly lower in the IV lidocaine group than in the control group at the post-anesthesia care unit (27.3% vs 68.2%, P < .001). The visual analog scale (0-10) score (median [interquartile range]) was lower in the IV lidocaine group than in the control group (0 [0-2]) vs 2 [0-4]), P < .001). The use of rescue analgesics and postoperative nausea and vomiting were similar between the 2 groups. This study demonstrated that administering 1.5 mg/kg of preoperative IV lidocaine can be a simple method to reduce incidence of pain after hysteroscopy. CONCLUSION Preoperative bolus administration of 1.5 mg/kg of IV lidocaine may be used to decrease incidence of pain after hysteroscopy under general anesthesia.
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Affiliation(s)
- Jiyoung Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
- Department of Medical Sciences, Graduate School of Ajou University, Suwon
| | - Seunghoon Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Heungwoo Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Chunghyun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
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Barel O, Preuss E, Stolovitch N, Weinberg S, Barzilay E, Pansky M. Addition of Lidocaine to the Distension Medium in Hysteroscopy Decreases Pain during the Procedure-A Randomized Double-blind, Placebo-controlled Trial. J Minim Invasive Gynecol 2020; 28:865-871. [PMID: 32798723 DOI: 10.1016/j.jmig.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To evaluate the effect of adding a local anesthetic to the distension medium in office diagnostic hysteroscopy using the vaginoscopic approach on pain during the procedure. Secondary aims included documenting side effects, patient satisfaction, and the time needed to complete the procedure. DESIGN Randomized double-blind placebo-controlled study. SETTING University-affiliated hospital; office hysteroscopy clinic. PATIENTS Total of 100 patients who underwent office hysteroscopies divided in half with 50 in the intervention group and 50 in the control group. INTERVENTIONS Ten mL of lidocaine 2% added to 1000 mL of saline solution that was used as the distension medium for hysteroscopy in the study group vs 1000 mL of saline alone in the control group. MEASUREMENTS AND MAIN RESULTS A significant difference was found in the increment of pain as measured by visual analog scale after the hysteroscopy between the 2 groups. Patients receiving lidocaine had an average rise of 1.9 in the visual analog scale score after the procedure compared with 2.9 in the control group (p = .033). There was also a nonsignificant trend for shorter duration of hysteroscopy in the intervention group compared with the control group (180.1 vs 222.1 seconds, p = .08). Patients' satisfaction was high in both groups (98% for the study group and 92% for the control group). Success rates were also similar between the 2 groups at approximately 95%. No side effects were recorded in either group. CONCLUSION The addition of local anesthetic to the distension medium in office hysteroscopy produces significant reduction in pain during the procedure without adding time to the procedure and without side effects.
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Affiliation(s)
- Oshri Barel
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod and Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel (all authors)..
| | - Elad Preuss
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod and Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel (all authors)
| | - Natan Stolovitch
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod and Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel (all authors)
| | - Shiri Weinberg
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod and Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel (all authors)
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod and Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel (all authors)
| | - Moty Pansky
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod and Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel (all authors)
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Prasad S, Trivedi P, Malhotra N, Patil M, Swaminathan D, Shukla S, Ganla K. Joint IFS-ISAR-ACE Recommendations on Resuming/Opening up Assisted Reproductive Technology Services. J Hum Reprod Sci 2020; 13:82-88. [PMID: 32792754 PMCID: PMC7394091 DOI: 10.4103/jhrs.jhrs_109_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
COVID-19 – A Global challenge on a scale not previously seen. Reproductive care is essential for the well-being of society and therefore the treatment needs to be completely re-thought and individualised. Infectivity and mortality rates are higher than previous pandemics and the disease is present in almost every country. Propagation and containment have varied widely by location and, at present, the timeline to complete resolution is unknown. With successful mitigation strategies in some areas and emergence of additional data, the societies have sanctioned gradual and judicious resumption of delivery of full reproductive care. When we resume, monitor local conditions, including prevalence of disease, status of government or state regulations, and availability of resource. It is important to implement proactive risk assessment within their practices prior to restarting services. One needs to develop clear and modified plans to ensure the ability to provide care while maximizing the safety of their patients and staff. One should also remain informed and stay current regarding new medical findings. These recommendations provide resources for restarting ART practice again.
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Affiliation(s)
- Sudha Prasad
- President, Indian Fertility Society; Director, Matritava - Advanced IVF and Training Center, Delhi, India
| | - Prakash Trivedi
- President, Indian Society for Assisted Reproduction; Director, Dr. Trivedi's Total Health Care Hospital & Aakar IVF-ICSI Centre, Mumbai India; Gynae Laparoscopist, Urogynecologist & ART Consultant Fortis Hospital, Mulund, Mumb Mulund, Mumbai, India
| | - Neena Malhotra
- Secretary, Indian Fertility Society; Professor, Consultant, ART Centre, Department of All India Institute of Medical Sciences, New Delhi, India
| | - Madhuri Patil
- Editor in Chief, Journal of Human Reproductive Sciences; Clinical Director, Dr Patil's Fertility and Endoscopy Clinic, Bangalore, India
| | - Dakshinamoorthy Swaminathan
- President, Academy of Clinical Embryologists, INDIA [ACE]; Scientific Director; Santhathi Centre For Reproductive Medicine, Mangalore, India
| | - Sanjay Shukla
- Secretary, Academy of Clinical Embryologists; Lab Director, Baheti Hospital & Centre for Reproductive Healthcare, Jaipur, India
| | - Kedar Ganla
- Secretary, Indian Society for Assisted Reproduction, Fertility Consultant, Ankur Fertility Clinic, Mumbai, India
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De Silva PM, Carnegy A, Smith PP, Clark TJ. Local anaesthesia for office hysteroscopy: A systematic review & meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252:70-81. [PMID: 32570188 DOI: 10.1016/j.ejogrb.2020.05.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare the effects of different types and routes of administration of local anaesthetic for pain control during and after office hysteroscopy. METHODS Medline, Embase, CINAHL and the Cochrane library were searched from inception until October 2019, in order to perform a systematic review and meta-analysis of all randomised controlled trials investigating the use of a local anaesthetic compared to a control, for pain relief in women undergoing diagnostic or operative office hysteroscopy. Average pain scores and data regarding side-effects, feasibility, complications, acceptability and satisfaction were collected. RESULTS The literature search yielded 612 citations. A total of 37 studies were included for systematic review, of which data from 20 studies were used for meta-analysis. Local anaesthesia was associated with significantly reduced pain during (SMD -0.57, 95 % CI -0.79 to -0.34) and after (SMD -0.30, 95 % CI -0.54 to -0.06) office hysteroscopy but did not reduce vasovagal episodes (OR 0.73, 95 % CI 0.50-1.09). A reduction in intra-procedural pain was observed regardless of type or route of administration. Local anaesthesia did not significantly reduce the risk of procedural failure (OR 0.72, 95 % CI 0.47-1.11). Insufficient data regarding complications, acceptability and satisfaction were available for meta-analysis. CONCLUSION Local anaesthesia via any route of genital tract administration, should be considered when undertaking office diagnostic or operative hysteroscopy to reduce pain during and after the procedure. Further research is needed to understand whether the pain control benefits of local anaesthesia remain apparent with vaginoscopic approaches to office hysteroscopy that avoid genital tract instrumentation.
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Affiliation(s)
- Prathiba M De Silva
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Alasdair Carnegy
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Paul P Smith
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - T Justin Clark
- Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TG, UK
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Selim MF, Abdou MMA, Mohamed ZE. Bilateral Ultrasound-Guided Erector-Spine Plane Block Versus General Anesthesia for Operative Hysteroscopic Polypectomy. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2019.0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE). ACTA ACUST UNITED AC 2017; 14:6. [PMID: 28603474 PMCID: PMC5440524 DOI: 10.1186/s10397-017-1007-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/23/2017] [Indexed: 11/22/2022]
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10
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Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol 2017; 40:3-22. [DOI: 10.1016/j.bpobgyn.2016.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/23/2016] [Indexed: 02/01/2023]
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del Valle C, Solano JA, Rodríguez A, Alonso M. Pain management in outpatient hysteroscopy. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2016.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Mahomed K, McLean J, Ahmed M, Zolotarev B, Shaddock N. Intrauterine anaesthetic after hysteroscopy to reduce post-operative pain - A double blind randomised controlled trial. Aust N Z J Obstet Gynaecol 2016; 56:484-488. [DOI: 10.1111/ajo.12498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/27/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kassam Mahomed
- Department of Obstetrics and Gynaecology; Ipswich Hospital and University of Queensland; Ipswich Queensland Australia
| | - Jim McLean
- Department of Anaesthetics; Ipswich Hospital; Ipswich Queensland Australia
| | - Muhtashim Ahmed
- Department of Medical Services, Clinical Governance, Education and Research; Ipswich Hospital; Ipswich Queensland Australia
| | - Boris Zolotarev
- Department of Obstetrics and Gynaecology; Ipswich Hospital and University of Queensland; Ipswich Queensland Australia
| | - Natalie Shaddock
- Department of Obstetrics; Ipswich Hospital; Ipswich Queensland Australia
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Hysteroscopic local anesthetic intrauterine cornual block in office endometrial ablation: a randomized controlled trial. Fertil Steril 2016; 105:474-80.e1. [DOI: 10.1016/j.fertnstert.2015.10.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/13/2015] [Accepted: 10/17/2015] [Indexed: 11/30/2022]
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Kumar V, Chodankar R, Gupta JK. Endometrial ablation for heavy menstrual bleeding. ACTA ACUST UNITED AC 2016; 12:45-52. [PMID: 26756668 DOI: 10.2217/whe.15.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometrial ablation can be described as one of the great gynecological success stories. It has changed the management of heavy menstrual bleeding dramatically. The development of newer (second generation) endometrial ablative techniques has enabled clinicians to set up comprehensive 'one stop clinics' based on an outpatient service to treat heavy menstrual bleeding effectively without the need for general anesthetic or conscious sedation. This article describes the rationale and evidence for use of different endometrial auto-ablative systems along with relevant technical and clinical aspects. It also addresses the essentials of a successful approach to outpatient endometrial ablation along with discussion on risks, complications and contraindications of the procedure.
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Affiliation(s)
- Vinod Kumar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rohan Chodankar
- Heatherwood & Wexham Park Hospitals NHS Foundation Trust, Slough, UK
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Munro MG. Reply: To PMID 25596171. J Minim Invasive Gynecol 2015; 22:1117-8. [PMID: 26134149 DOI: 10.1016/j.jmig.2015.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 11/27/2022]
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Abstract
This review summarises current understanding and research on the association between anxiety and outpatient hysteroscopy. Women undergoing hysteroscopy suffer from significant levels of anxiety, with repercussions on pain perception, success rates and satisfaction. Using validated tools such as the Spielberger State-Trait Anxiety Index (STAI) or the Hospital Anxiety and Depression Scale (HADS) in the outpatient hysteroscopy setting, average state anxiety scores similar or greater than those measured before more invasive procedures under general anaesthesia have been consistently reported. This clearly suggests a significant gap between our clinical viewpoint of what is "minimally invasive" and patients' expectations. In spite of its potential role of confounder in studies on pain-reduction interventions, we found that patient anxiety was evaluated in only 9 (13 %) out of a sample of 70 randomised controlled trials on outpatient hysteroscopy published since 1992. Factors such as trait anxiety, age, indication and the efficiency of the clinic can be correlated to state anxiety before hysteroscopy, but more robust data are needed. Promising non-pharmacological interventions to reduce anxiety at hysteroscopy include patient education, communication through traditional or multimedia approaches, interaction and support during the procedure and music listening.
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Centini G, Calonaci A, Lazzeri L, Tosti C, Palomba C, Puzzutiello R, Luisi S, Petraglia F, Zupi E. Parenterally Administered Moderate Sedation and Paracervical Block Versus General Anesthesia for Hysteroscopic Polypectomy: A Pilot Study Comparing Postoperative Outcomes. J Minim Invasive Gynecol 2015; 22:193-8. [DOI: 10.1016/j.jmig.2014.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/05/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
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Arnau B, Jovell E, Romero M, Gonzalez M, Esteba L, Garcia A. Lidocaine–prilocaine cream as analgesia for hysterosalpingography: a randomized, double blinded, controlled study. Eur J Obstet Gynecol Reprod Biol 2014; 182:216-9. [DOI: 10.1016/j.ejogrb.2014.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 11/30/2022]
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Cobellis L, Castaldi MA, Giordano V, De Franciscis P, Signoriello G, Colacurci N. Is it possible to predict office hysteroscopy failure? Eur J Obstet Gynecol Reprod Biol 2014; 181:328-33. [DOI: 10.1016/j.ejogrb.2014.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/04/2014] [Accepted: 08/07/2014] [Indexed: 11/26/2022]
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A Randomized, Single Blind, Placebo-Controlled Trial for the Pain Reduction During the Outpatient Hysteroscopy After Ketoprofen or Intravaginal Misoprostol. J Minim Invasive Gynecol 2014; 21:921-7. [DOI: 10.1016/j.jmig.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
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Keyhan S, Munro MG. Office Diagnostic and Operative Hysteroscopy Using Local Anesthesia Only: An Analysis of Patient Reported Pain and Other Procedural Outcomes. J Minim Invasive Gynecol 2014; 21:791-8. [DOI: 10.1016/j.jmig.2014.03.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/02/2014] [Accepted: 03/05/2014] [Indexed: 11/29/2022]
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Carabias P, Celades-Filella M, Zapardiel I, Alsina-Maqueda A, Genover-Llimona E. Experience and results of office hysteroscopy at a primary hospital. J OBSTET GYNAECOL 2013; 34:54-6. [PMID: 24359051 DOI: 10.3109/01443615.2013.782277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our aim was to analyse, retrospectively, the perioperative outcomes of 3,488 office hysteroscopies. Age, menopausal status, parity, medical indications, use or not of anaesthesia, incidents, presence of pathology in the cavity, endometrial pathology, type of surgery and pain assessment details were collected. The mean age of patients was 52.1 years. The most common medical indication was suspicious ultrasound for endometrial disease, and the most frequent symptom was metrorrhagia. We did not use any type of anaesthesia in 89.5% of patients and we could access the uterine cavity in 99.4% of cases. The complication rate was very low though 12% of patients reported severe pain while performing the test. Although office hysteroscopy in outpatients is fully established and is usually well tolerated, there is a group of patients who could benefit from analgesic treatment prior to the test, to improve their tolerance.
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Affiliation(s)
- P Carabias
- Department of Obstetrics and Gynecology, Mataró Hospital , Barcelona
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Hysteroscopic local anaesthetic intrauterine cornual ‘focal local’ block before endometrial ablation with direct cervical block in an outpatient setting: a feasibility study. Eur J Obstet Gynecol Reprod Biol 2013; 170:222-4. [DOI: 10.1016/j.ejogrb.2013.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/01/2013] [Accepted: 06/03/2013] [Indexed: 11/24/2022]
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Arnau B, Jovell E, Redón S, Canals M, Mir V, Jiménez E. Lidocaine-prilocaine (EMLA®) cream as analgesia in hysteroscopy practice: a prospective, randomized, non-blinded, controlled study. Acta Obstet Gynecol Scand 2013; 92:978-81. [DOI: 10.1111/aogs.12165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Baldomero Arnau
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Esther Jovell
- Epidemiology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Stephanie Redón
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Marta Canals
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Vanessa Mir
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Elena Jiménez
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
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Wortman M, Daggett A, Ball C. Operative Hysteroscopy in an Office-Based Surgical Setting: Review of Patient Safety and Satisfaction in 414 Cases. J Minim Invasive Gynecol 2013; 20:56-63. [DOI: 10.1016/j.jmig.2012.08.778] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/20/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
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Lee SC, Seibel B, Kaunitz AM. When Should Endometrial Polyps Be Treated? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2012. [DOI: 10.1007/s13669-012-0012-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Munro MG. Uterine Leiomyomas, Current Concepts: Pathogenesis, Impact on Reproductive Health, and Medical, Procedural, and Surgical Management. Obstet Gynecol Clin North Am 2011; 38:703-31. [DOI: 10.1016/j.ogc.2011.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Current world literature. Curr Opin Anaesthesiol 2011; 24:592-8. [PMID: 21900764 DOI: 10.1097/aco.0b013e32834be5b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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