The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy

Comparing Transcervical Intrauterine Lidocaine Instillation with Rectal Diclofenac for Pain Relief During Outpatient Hysteroscopy: A Randomized Controlled Trial

OBJECTIVES

There are a number of potential advantages to performing hysteroscopy in an outpatient setting. However, the ideal approach, using local uterine anesthesia or rectal non-steroidal anti-inflammatory drugs, has not been determined. Our objective was to compare the efficacy of intrauterine lidocaine instillation with rectal diclofenac for pain relief during diagnostic hysteroscopy.

METHODS

We conducted a double-blind randomized controlled trial on 70 nulliparous women with primary infertility undergoing diagnostic hysteroscopy. Subjects were assigned into one of two groups to receive either 100mg of rectal diclofenac or 5mL of 2% intrauterine lidocaine. The intensity of pain was measured by a numeric rating scale 0-10. Pain scoring was performed during insertion of the hysteroscope, during visualization of the intrauterine cavity, and during extrusion of the hysteroscope.

RESULTS

There were no statistically significant differences between the groups with regard to the mean pain score during intrauterine visualization (p=0.500). The mean pain score was significantly lower during insertion and extrusion of the hysteroscope in the diclofenac group (p=0.001 and p=0.030, respectively). Nine patients in the lidocaine group and five patients in diclofenac group needed supplementary intravenous propofol injection for sedation (p=0.060).

CONCLUSIONS

Rectal diclofenac appears to be more effective than intrauterine lidocaine in reducing pain during insertion and extrusion of hysteroscope, but there are no significant statistical and clinical differences between the two methods with regard to the mean pain score during intrauterine inspection.

Efficacy of intravenous tramadol treatment for reducing pain during office diagnostic hysteroscopy

OBJECTIVE

To assess whether IV tramadol before outpatient hysteroscopy could reduce procedure-related pain.

DESIGN

A randomized double-blind placebo controlled trial.

SETTING

Outpatient Hysteroscopy Centre in the Department of Obstetrics and Gynaecology of Cagliari University.

PATIENT(S)

Fifty healthy, parous, women who underwent outpatient diagnostic hysteroscopy and endometrial biopsy.

INTERVENTION(S)

Random IV infusion of tramadol or placebo before hysteroscopy and endometrial biopsy were performed.

MAIN OUTCOME MEASURE(S)

Visual analogue scale of pain was measured both immediately after and 15 minutes after the procedure. Stress hormones (ACTH, cortisol), blood pressure, and heart frequency were evaluated before, during, and 15 minutes after the procedure.

RESULT(S)

In the tramadol group, the visual analogue scale of pain was significantly lower than in the placebo group both immediately after the procedure and 15 minutes later. Basal levels of ACTH and cortisol did not differ between the groups. In both groups, the ACTH levels remained unchanged during the study, and the cortisol levels were higher 15 minutes after the procedure than before the procedure. Procedure time, heart frequency, blood pressure, and adverse effects did not differ between the groups.

CONCLUSION(S)

In parous women without uterine malformations, a treatment with tramadol before hysteroscopy and endometrial biopsy appears to be capable of reducing the pain and discomfort that are associated with this procedure.