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Twidale EK, Neutens S, Hynt L, Dudley N, Streeton C. Methoxyflurane analgesia for outpatient hysteroscopy: A double-blind, randomised, controlled trial. Aust N Z J Obstet Gynaecol 2024. [PMID: 39007504 DOI: 10.1111/ajo.13861] [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: 12/21/2023] [Accepted: 06/23/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Despite clinical and economic benefits, pain during outpatient hysteroscopy (OPH) remains a barrier to use. There is a lack of evidence to support routine use of one analgesic over another versus no analgesic. AIMS To study the efficacy and safety of methoxyflurane analgesia during OPH. MATERIALS AND METHODS A single-centre, randomised, double-blind, placebo-controlled experiment was performed; 90 patients were randomly assigned (1:1). Participants allocated to the treatment group (cases) received 3 mL of methoxyflurane through an inhaler. The control group received a placebo. The primary outcome was a mean difference in pain, via a change in Visual Analog Scale (VAS) score from baseline at diagnostic hysteroscopy. Secondary outcomes were a mean difference in VAS score with any subsequent operative procedures; a mean difference in VAS score at 15 min post-procedure; participant and clinician-reported adverse effects and events; and participant-reported procedure acceptability, adjuvant nitrous oxide (N2O2) use and a composite of 'distress'. RESULTS During diagnostic hysteroscopy, there was a mean difference of 11.5 mm/100 (95% confidence interval (CI) 0.08-22.95), P = 0.05, with the lower score in the cases, compared with controls. During subsequent operative procedures, there was a mean difference of 15 mm/100 (95% CI 2.71-28.22), P = 0.02, with the lower pain score in the cases, compared with controls. There was no significant difference in pain 15 min post-procedure, participant- and clinician- reported adverse effects and events, procedure acceptability and the 'distress' composite. CONCLUSIONS Methoxyflurane significantly reduced pain during OPH compared with placebo, for diagnostic as well as operative procedures. Furthermore, methoxyflurane was well tolerated, with no adverse events.
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Affiliation(s)
- Emily K Twidale
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Sofie Neutens
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Lyn Hynt
- Department of Computing and Mathematical Sciences, The University of Waikato, Hamilton, New Zealand
| | - Narena Dudley
- Department of Women's Health, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Catherine Streeton
- Department of Gynaecology, Abortion and Contraception Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
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Rashwan ASSA, Alalfy M, Elkomaty SA, Helal OM, Hussein EA. Diclofenac Potassium Alone Versus Diclofenac Potassium with Hyoscine-N-butyl Bromide (HBB) in Reduction of Pain in Women Undergoing Office Hysteroscopy: A Double Blind Randomized, Placebo-Controlled Trial. J Obstet Gynaecol India 2022; 72:340-345. [PMID: 35928098 PMCID: PMC9343497 DOI: 10.1007/s13224-022-01648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
Study Objective To compare between oral diclofenac potassium alone versus a combination of it with hyoscine-N-butyl bromide (HBB) in reduction of pain in women undergoing office hysteroscopy. Design Randomized, double-blind controlled trial. Setting Kasralainy hospital (a tertiary hospital). Intervention Sixty-Four patients undergoing office hysteroscopy were randomly divided into 2 groups (study group and placebo group) in the ratio of 1:1. Group 1 (study group = 32 participants) received two oral HBB tablets and one tablet of diclofenac potassium and group 2 (placebo group = 32 participants) received two oral placebo tablet similar in size, structure and color to buscopan in addition to the diclofenac tablet. The patient was given the drugs 30-60 min before the procedure. Results There was statistically significant difference between the two groups in the pain score immediately during entry (p value = 0.001) and after 30 min of the procedure (p value = < 0.001). And there was a statistically significant difference as regards the side effects (gastric irritation) of the medications (p value = 0.04) between the women participating in the two groups. Conclusion The combination of diclofenac potassium and HBB helps a lot in decreasing the pain and discomfort during and after performing office hysteroscopy but with more gastric side effects.
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Marchand GJ, Kurdi W, Sainz K, Maarouf H, Ware K, Masoud AT, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Ulibarri H, Parise J, Arroyo A, Chen D, Pierson M, Rafie R, Shareef MA. Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis. J Turk Ger Gynecol Assoc 2022; 23:51-57. [PMID: 34866373 PMCID: PMC8907440 DOI: 10.4274/jtgga.galenos.2021.2021-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We conducted a systematic review and meta-analysis of relevant clinical trials from full-text, scientific journal archives to assess the efficacy of hyoscine for the management of pain during in-office hysteroscopy (OH) procedures. Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE, PubMed, SCOPUS and the Web of Science were searched for all clinical trials that matched our search criteria. A full assessment of bias was made using the Cochrane Group tool-set. The following outcomes were included: visual analogue scale (VAS) score for postoperative pain, postoperative need for analgesia, and procedure time. In the case of homogeneous data, the analysis was performed using a fixed effects system, and the random effects system was used with heterogeneous data. Inclusion criteria included only randomized clinical trials, and interventions that included patients receiving hyoscine-N-Butyl Bromide during OH, regardless of dose or mode of administration, and compared this with placebo. Three clinical trials were included. The actual mean difference (MD) of the VAS pain score showed no significant difference between hyoscine or placebo [MD: -0.28 (-1.08, 0.52), (p=0.49)]. For postoperative analgesia, the overall MD showed no significant difference between hyoscine or placebo [MD: 0.43 (0.16, 1.14), (p=0.09)]. For procedure time, the combined effect estimate failed to show any significant difference between hyoscine and placebo [MD: -0.66 (-2.77, 1.44) (p=0.54)]. Contrary to previously published data, our meta-analysis using the latest available RCTs fails to show hyoscine as being effective in reducing pain or the need for other forms of anesthesia in OH.
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Affiliation(s)
- Greg J. Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Wesam Kurdi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Hiba Maarouf
- REProVita Fertility Center, Recklinghausen, Germany
| | - Kelly Ware
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Ahmed Taher Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America,Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Nicolas Calteux
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Hollie Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Julia Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Amanda Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Diana Chen
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, United States of America
| | - Maria Pierson
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, United States of America
| | - Rasa Rafie
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States of America
| | - Mohammad Abrar Shareef
- Department of Internal Medicine, Sebasticook Valley Hospital, Pittsfield, ME, United States of America
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Vitale SG, Alonso Pacheco L, Haimovich S, Riemma G, De Angelis MC, Carugno J, Lasmar RB, Di Spiezio Sardo A. Pain management for in-office hysteroscopy. A practical decalogue for the operator. J Gynecol Obstet Hum Reprod 2020; 50:101976. [PMID: 33166706 DOI: 10.1016/j.jogoh.2020.101976] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Abstract
Hysteroscopy is known to be the gold standard for evaluation of intrauterine pathologies, pre-menopausal and post-menopausal abnormal uterine bleeding and, in addition to this, it is a crucial examination in the infertility work-up. In-office operative hysteroscopy incorporates the outstanding possibility of seeing and treating an intracavitary pathology in the same examination, eliminating all the risk related to anesthesia and reducing procedure-related costs. By now, performing operative procedures in the office setting is recognized as feasible and safe. Over the last 20 years, many efforts have been made to implement the in-office operative approach worldwide. However, for some women, in-office hysteroscopy is still considered a painful experience, with reported discomfort at different steps of the hysteroscopic procedures. Moreover, uneventful and tedious sensations might be increased by a high level of anxiety for such examination. For this reason, despite the feasibility of the in-office approach, many clinicians are still afraid of provoking pain during the procedure and rather not to perform surgical procedures in the office, postponing the removal of the pathology in the operating room. To date, there is no consensus concerning pain management for in-office hysteroscopy and different approaches, pharmacological and non-pharmacological aids, as well as several procedural tips and tricks are utilized. Our purpose is to provide a feasible practical decalogue for the operator, to supply adequate management of pain during in-office hysteroscopic procedures, performing challenging operations, shrinking discomfort, aiming to upgrade both women's and operator's satisfaction.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
| | | | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera, Israel
| | - Gaetano Riemma
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Farghaly TA, Fawzy M, Abbas AM. Practice recommendations for clinicians in ART centers in the context of COVID-19 pandemic: perspective of a developing country. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2020; 25:28. [PMID: 32958990 PMCID: PMC7495964 DOI: 10.1186/s43043-020-00040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Tarek A. Farghaly
- Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Fawzy
- IVF Laboratory, IbnSina IVF Center, IbnSina Hospital, Sohag, Egypt
| | - Ahmed M. Abbas
- Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
- Women Health Hospital, Assiut, 71511 Egypt
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Analgesia for Office Hysteroscopy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:1034-1047. [DOI: 10.1016/j.jmig.2020.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/18/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022]
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Gokmen Karasu AF, Aydin S, Ates S, Takmaz T, Comba C. Administration of rectal cytotec versus rectal buscopan before hysteroscopy. MINIM INVASIV THER 2020; 31:94-98. [PMID: 32491923 DOI: 10.1080/13645706.2020.1748059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Our objective was to compare the effect of rectal misoprostol (Cytotec) versus rectal hyoscine-n-butyl bromide (Buscopan) on patients undergoing hysteroscopy. We hypothesised that HBB may have a role in cervical priming.Material and methods: This trial was conducted at Bezmialem Vakif University Hospital. Women of reproductive age between 18-50 years who were scheduled for operative hysteroscopy indicated by type 1 submucous myoma or endometrial polyps were recruited for the study. Ninety patients were divided randomly into three groups. Group 1 received placebo treatment. Group 2 received rectal 200 mcg misoprostol and Group 3 received rectal 20 mg hyoscine-n-butyl bromide two hours before the procedure. Procedures were performed using a bipolar 26 F (9 mm) continuous-flow rigid resectoscope with a 30° lens. The outcome measures included cervical dilation width and time, ease of cervical dilation, procedure time and operative complications. Postoperative self-rated pain was assessed one hour after the procedure.Results: Thirteen patients (43. 3%) in the placebo treatment group, 11 patients (36.7%) in the misoprostol group and four patients (13.3%) in the hyoscine-n-butyl bromide group needed analgesics postoperatively (p = .02). The mean duration of cervical dilation time was longest in Group 1 and shortest in Group 3, however this difference did not reach statistical significance (p=.11). There was no difference with regard to other studied parameters.Summary: HBB reduced the need for pain medication compared to placebo. Larger studies are needed to further investigate the role of HBB in facilitating pre-operative cervical priming.
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Affiliation(s)
- Ayse Filiz Gokmen Karasu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Serdar Aydin
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Seda Ates
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Taha Takmaz
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Cihan Comba
- Department of Gynecologic Oncology, Bakirkoy Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Riemma G, Schiattarella A, Colacurci N, Vitale SG, Cianci S, Cianci A, De Franciscis P. Pharmacological and non-pharmacological pain relief for office hysteroscopy: an up-to-date review. Climacteric 2020; 23:376-383. [PMID: 32396751 DOI: 10.1080/13697137.2020.1754388] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In-office hysteroscopy is considered the standard technique for visualization of the uterine cavity and the diagnosis of intrauterine pathologies. Moreover, nowadays, it is possible to treat a vast number of intracavitary diseases in the office, without the need for the inpatient setting. However, in some cases, pain might occur, and this is the most common reason for not completing the procedure. Over the last 20 years, many efforts have been carried out to miniaturize the instrumentation and to improve the techniques in order to avoid discomfort. Nonetheless, hysteroscopy still provokes distress for many patients. For this reason, pharmacological and non-pharmacological treatments for intraoperative and postoperative pain relief have been widely used for in-office hysteroscopy, with different results in various groups of women. The purpose of this review was to analyze the current literature on pharmacological aids (non-steroidal anti inflammatory drugs, cyclooxygenase-2 inhibitors, antispasmodics, local anesthetics, prostaglandins, opioids) and non-pharmacological interventions (transcutaneous electrical nerve stimulation, uterine stretching, uterine pressure, warming of distension medium, hypnosis, music, vocal-local) and to evaluate their impact on the relief from pain experienced during in-office hysteroscopy.
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Affiliation(s)
- G Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - N Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - S G Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - S Cianci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - P De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Samy A, Abbas AM, Rashwan AS, Talaat B, Eissa AI, Metwally AA, Hammad BEM, Ibrahim AM, Elzahaby IM, Zaki SS, El Sharkawy M. Vaginal Dinoprostone in Reducing Pain Perception During Diagnostic Office Hysteroscopy in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Trial. J Minim Invasive Gynecol 2020; 27:847-853. [DOI: 10.1016/j.jmig.2019.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/17/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022]
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10
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Ghamry NK, Samy A, Abdelhakim AM, Elgebaly A, Ibrahim S, Ahmed AA, Abdelbaky WH, Abdallah KM, Badawy MA, Mohammed AH, Hamza M. Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: A systematic review and network meta-analysis. J Obstet Gynaecol Res 2020; 46:807-827. [PMID: 32088931 DOI: 10.1111/jog.14221] [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: 11/12/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
AIM To identify the highest-ranked pharmacological and nonpharmacological interventions for pain relief during outpatient hysteroscopy. METHODS We conducted an online bibliographic search in different databases from inception till July 2019. We included randomized controlled trials assessing effect of pharmacological and nonpharmacological interventions on pain relief during outpatient hysteroscopy. Our main outcomes were pain scores at different endpoints of the procedure. We applied this network meta-analysis based on the frequentist approach using statistical package 'netmeta' (version 1.0-1) in R. RESULTS The review included 39 randomized controlled trials (Women n = 3964). Misoprostol plus intracervical block anesthesia (mean difference [MD] = -3.32, 95% confidence interval [CI] [-6.06, -0.59]), misoprostol (MD = -1.92, 95% CI [-3.04, -0.81]) and IV analgesia (MD = -2.01, 95% CI [-3.27, -0.25]) were effective in reducing pain during the procedure compared to placebo. Ranking probability showed that misoprostol plus intracervical block anesthesia was the highest ranked pharmacological treatment for pain relief during the procedure (P score = 0.92) followed by misoprostol alone (P score = 0.78), and IV analgesia (P score = 0.76). Regarding nonpharmacological treatments, transcutaneous electrical nerve stimulation (TENS) showed a significant pain reduction compared to placebo (MD = -1.80, 95% CI [-3.31, -0.29]). TENS ranked as the best nonpharmacological treatment (P score = 0.80) followed by CO2 distention (P score = 0.65) and bladder distention (P score = 0.60). CONCLUSION Combination of misoprostol plus local anesthesia appears to be the most effective pharmacological approach for pain reduction during and after outpatient hysteroscopy. Nonpharmacological approaches as TENS and bladder distention showed considerable efficacy but should be further investigated.
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Affiliation(s)
- Nevein K Ghamry
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Safaa Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal A Ahmed
- Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Waleed H Abdelbaky
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Khaled M Abdallah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Mahmoud A Badawy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Ahmed H Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Mohamed Hamza
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Vitale SG, Bruni S, Chiofalo B, Riemma G, Lasmar RB. Updates in office hysteroscopy: a practical decalogue to perform a correct procedure. Updates Surg 2020; 72:967-976. [PMID: 32008214 DOI: 10.1007/s13304-020-00713-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Nowadays, hysteroscopy is the gold standard for the diagnosis and treatment of intrauterine pathologies as it represents a safe and minimally invasive procedure that allows the visualization of the entire uterine cavity. Numerous technological innovations have occurred over the past few years, contributing to the development and widespread use of this technique. In particular, the new small-diameter hysteroscopes are equipped with an operating channel in which different mechanical instruments can be inserted, and they allow not only to examine the cervical canal and uterine cavity but also to perform biopsies or treat benign diseases in a relatively short time without anesthesia and in an outpatient setting. In this scenario, the operator must be able to perform hysteroscopy in the correct way to make this procedure increasingly safe and painless for the patient. This review aims to describe the ten steps to perform a correct office hysteroscopy, starting from patient counseling to the therapy after the procedure.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
| | - Simone Bruni
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gaetano Riemma
- Department of Women, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ricardo Bassil Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro, Brazil
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12
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Török P, Molnár S, Herman T, Jashanjeet S, Lampé R, Riemma G, Vitale SG. Fallopian tubal obstruction is associated with increased pain experienced during office hysteroscopy: a retrospective study. Updates Surg 2020; 72:213-218. [PMID: 31993995 DOI: 10.1007/s13304-020-00712-x] [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: 12/05/2019] [Accepted: 01/22/2020] [Indexed: 01/30/2023]
Abstract
This study aimed at evaluating the pain experienced during office hysteroscopy, with selective tubal cannulation and chromopertubation, by women with and without tubal obstruction in order to determine if such condition would be associated with increased pain during the examination. Women with a history of infertility underwent in-office hysteroscopy with selective chromopertubation using a continuous flow office hysteroscope with a 5 Fr operating channel fitted with a 4 Fr catheter for the injection of methylene blue dye. Experienced pain was recorded on a Visual Analog Scale (VAS) during diagnostic hysteroscopy after access to the uterine cavity. Of 90 women, 58 (66.4%) were found with at least one patent fallopian tube and inserted in the group "any", meanwhile 32 (33.6%) were categorized into group "none" as both tubes were judged obstructed. There was no significant difference between groups in BMI and primary infertility rate, but the difference was significant concerning mean age (32.6 vs. 35.8; p < 0.001). The mean VAS score was 3.34 (± 1.07) in the group "any" and 4.25 (± 1.11) in "none". Comparing the VAS score of the two groups, the difference was significant (p < 0.001). Tubal occlusion may have a potential role in the pain experienced by women undergoing in-office hysteroscopy. Women with bilateral tubal occlusion experienced a higher level of pain compared with patients with at least one patent fallopian tube. Operators may use milder intrauterine pressure of fluid distension medium when these patients are undergoing in-office hysteroscopy to reduce discomfort.
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Affiliation(s)
- Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Molnár
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Tünde Herman
- Center for Assisted Reproduction, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Singh Jashanjeet
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Rudolf Lampé
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
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Bharathi S, Maurya DK, Keepanasseril A, Kubera NS. Efficacy and safety of Tramadol as an analgesic in women undergoing vaginoscopic hysteroscopy: a randomized placebo-controlled trial. J OBSTET GYNAECOL 2019; 40:678-683. [PMID: 31462117 DOI: 10.1080/01443615.2019.1647525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pain or discomfort during the hysteroscopy remains a challenge even after the introduction of small calibre instruments and vaginoscopic techniques. Tramadol, a centrally acting analgesic, is one among the medications used to reduce pain; however, the experience with its use in the vaginoscopic technique is limited. This was a randomised double-blind placebo-controlled trial conducted to study the effectiveness of oral Tramadol as an analgesic in 100 women undergoing diagnostic vaginoscopic hysteroscopy. Median pain score assessed by the Visual Analogue Scale was lower in the study group compared to the placebo group during the procedure (7 versus 8; p < .001) and immediately after the procedure (6 versus 7; p < .001) Ease of entry, procedure entry time and the adverse effects were similar in both the groups. Administration of oral Tramadol 50 mg, 1 h prior to the procedure may be a safe and effective analgesic in women undergoing diagnostic vaginoscopic hysteroscopy.Impact statementWhat is already known on this subject? Even with the use of newer hysteroscopes with small calibres and vaginoscopic techniques, pain and discomfort to the patient during negotiation through the cervix remain the main challenge to the surgeon. Among the several medications reported to reduce pain during the procedure, Tramadol a centrally acting drug with dual analgesic action, both by the µ opioid receptor agonist action and by the inhibiting uptake of serotonin and norepinephrine, can be used. However, studies using oral Tramadol during vaginoscopic hysteroscopy are limited.What do the results of this study add? The median pain score assessed by the Visual Analogue Scale was lower in the study group compared to the placebo group during the procedure (7 versus 8; p < .001) and immediately after the procedure (6 versus 7; p < .001). Ease of entry, procedure entry time and the adverse effects were similar in both the groups.What are the implications of these findings for clinical practice and/or further research? This study suggests that administration of oral Tramadol 50 mg, 1 h prior to the procedure, may be used as a safe and effective analgesic in women undergoing diagnostic vaginoscopic hysteroscopy. Future trial with a larger sample size is required to confirm the tolerability of its use, as the incidence of adverse effects was low in the study.
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Affiliation(s)
- Shree Bharathi
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry, India
| | - Dilip Kumar Maurya
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry, India
| | - N S Kubera
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry, India
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