A randomised controlled trial of intravenous versus inhalational analgesia during outpatient oocyte recovery

Abstract

SummaryTo compare the efficacy and acceptability of conventional intravenous sedation with patientcontrolled inhalational isodesox, 57 women undergoing outpatient oocyte recovery were randomly allocated to receive isodesox by face mask, while 55 women were given intravenous fentanyl and midazolam. Women's satisfaction with pain relief, peroperative pain, clouding of memory and the surgeons' assessment of operating conditions were evaluated. Thirty-eight women in the inhalation group (67%) and 41 (75%) women in the intravenous group were`very satisfied' with their analgesia (p 0.41). The mean (SD) pain score in women given isodesox was 46.8 (34.7), while in the intravenous group it was 34.1 (21.3) (p 0.02). Oxygen saturation levels , 94% were recorded in one woman using isodesox and in 16 (29%) women given intravenous analgesia. Despite higher pain scores, in comparison with the conventional analgesia, patient-controlled isodesox offers a safer method of pain relief with comparable satisfaction rates.

A randomised controlled trial to evaluate the effect of self‐administered analgesia on women's experience of outpatient treatment at colposcopy

“…It should be remembered that this subgroup analysis was not an a priori hypothesis. Self‐administered inhalation of isoflurane and desflurane has already been used with the aim of reducing the amount of intravenous sedation required for painful procedures such as oocyte recovery 21 . Due to the low numbers of women having LLETZ under general anaesthetic in our practice (see Fig.…”

“…Selfadministered inhalation of isoflurane and desflurane has already been used with the aim of reducing the amount of intravenous sedation required for painful procedures such as oocyte recovery. 21 Due to the low numbers of women having LLETZ under general anaesthetic in our practice (see Fig. 1), we would be unable to conduct a trial powered to compare outpatient isoflurane and desflurane with general anaesthetic.…”

Conscious sedation and analgesia for oocyte retrieval during IVF procedures: a Cochrane review

“…After full text review, 15 were excluded because conscious sedation was not one of the comparators. Twelve papers which met our inclusion criteria (Ramsewak et al, 1990;Zelcer et al, 1992;Cook et al, 1993;Bhattacharya et al, 1997;Ben-Shlomo et al, 1999;Stener-Victorin et al, 1999;Thompson et al, 2000;Ng et al, 2001;Lok et al, 2002;Ocal et al, 2002;Stener-Victorin et al, 2003;Humaidan and Stener-Victorin, 2004) involved 1349 women who underwent oocyte retrieval ( Figure 1). There were two main categories of trials: (1) those which compared the effect of conscious sedation with alternative methods (Table I) and (2) those which compared the effect of PCA with physicianadministered sedation/analgesia (Table II).…”

Anesthesia for Assisted Reproductive Technologies

“…The metabolic byproduct of sevoflurane, compound A, has been associated with genotoxic ovarian cell effects, although reproductive outcomes during ART procedures have not been assessed. 46 Caution is advised when selecting a volatile halogenated agent, especially, when contemplating the use of new agents such as sevoflurane, desflurane, and isodesox (a combination of 1% desflurane, 0.25% isoflurane, and 60% oxygen in nitrogen) 47 until further work has been done.…”

“…52 Self-administered inhalational analgesia with isodesox (see above) by face mask was associated with less effective analgesia and less patient satisfaction than physician-administered intravenous analgesia. 47 Because paracervical anesthesia incompletely blocks sensation from the vaginal and ovarian pain fibers, additional analgesia is required, even when increased doses of local anesthetic are used. 53 Epidural and spinal techniques provide excellent pain relief with minimal oocyte exposure to anesthetic agents.…”