Local anaesthesia for office hysteroscopy: A systematic review &amp; meta-analysis

Silva, Prathiba M. De; Carnegy, Alasdair; Smith, Paul; Clark, T. Justin

doi:10.1016/j.ejogrb.2020.05.062

Cited by 21 publications

(16 citation statements)

References 36 publications

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“…The results of a recent randomized controlled study indicate that the addition of lidocaine to the distention medium or oral tramadol facilitates the procedure in postmenopausal patients by reducing pain during the cervical transition 20 . Similarly, current meta‐analysis results and expert opinions suggest that local anesthesia, 24 nonsteroidal anti‐inflammatory drugs 25 and cervical ripening 26 are effective in pain during office hysteroscopy. However, there is insufficient good evidence to suggest that any approach is safe and effective in reducing pain during office hysteroscopy 27 .…”

Section: Discussionmentioning

confidence: 94%

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini‐hysteroscope?

Güraslan

Şentürk

Doğan

et al. 2022

J of Obstet and Gynaecol

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Aim To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini‐hysteroscope. Methods A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. Results Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n = 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p = 0.01; OR, 4.6; 95% CI, 1.7–13.2), postmenopausal state (p = 0.02; OR, 2.2; 95% CI, 1.2–4.3), excessive flexion of the cervix and retroverted uterus (p <0.001; OR, 4.1; 95% CI, 2.0–8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. Conclusion In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.

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Section: Discussionmentioning

confidence: 94%

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini‐hysteroscope?

Güraslan

Şentürk

Doğan

et al. 2022

J of Obstet and Gynaecol

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“…Concerns regarding the rate of failed procedures owing to the inability to access the endometrial cavity seem to be addressed by some combination of technique, instrument diameter, and the use of local anesthesia. The mean reported failure rate in a systematic review randomized trials comprising 2513 women was 3.9% [8] whereas in a high-volume operative hysteroscopy unit directed by one of the authors (M.G.M. ), the rate was 1.3% with failed access encountered in only 0.5% [7].…”

Section: Discussionmentioning

confidence: 95%

Office versus Institutional Operative Hysteroscopy: An Economic Model

Munro

Kasiewicz

Desai

2022

Journal of Minimally Invasive Gynecology

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Study Objective: Model and compare estimated health system costs and gynecologic practice revenues when hysteroscopic surgery is performed in the office or institutional setting, either an ambulatory surgical center (ASC) or a traditional operating room (OR). Design: Economic modeling exercise. Interventions: Nonclinical. Measurements and Main Results: An economic model was developed that included US reimbursement rates for the office and institutional settings and the inherent expenses required for office hysteroscopic surgery.

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“…There is no international consensus regarding which anesthesia regimen is optimal for hysteroscopy ( 19 ). The invention of small and flexible hysteroscopes has reduced the need for anesthesia and has enabled hysteroscopy to be completed with local anesthesia in an outpatient setting ( 20 – 22 ). However, it should be remembered that pain tolerance in office hysteroscopy depends on the skill of the operator performing the paracervical block or topical anesthesia.…”

Section: Discussionmentioning

confidence: 99%

High-flow nasal oxygen reduces the incidence of hypoxia in sedated hysteroscopy for assisted reproduction

et al. 2022

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Backgrounds and aimsPain is the main reason for hysteroscopy failure. In day-surgical settings, hysteroscopy procedures are commonly performed with the patient under sedation. Hypoxia is the most common adverse event during sedation and can lead to severe adverse events. This study aimed to compare the incidence of hypoxia when using high-flow nasal oxygen (HFNO) with that when using regular nasal oxygen in patients undergoing hysteroscopy with sedation.Materials and methodsIn this single-center, prospective, randomized, single-blinded study, 960 female patients undergoing elective diagnostic or operative hysteroscopy were randomly enrolled into the following two groups: the regular nasal group [O2 (3–6 L/min) covered by an HFNO] and the HFNO group [O2 (30–60 L/min)] from September 2021 to December 2021. All women were sedated with propofol (1.5 mg/kg) and remifentanil (1.5 μg/kg) in the operating room. The primary outcome was the incidence of hypoxia (75% ≤ SpO2 < 90%, < 60 s).ResultsHFNO decreased the incidence of hypoxia (75% ≤ SpO2 < 90%, < 60 s), subclinical respiratory depression (90% ≤ SpO2 < 95%) and severe hypoxia (SpO2 < 75% for any duration or 75% ≤ SpO2 < 90% for ≥ 60 s) from 24.38 to 0.83%, from 11.25 to 1.46% and from 3.75 to 0%, respectively (P < 0.001).ConclusionIn procedures conducted to treat female infertility, HFNO can reduce hypoxia during hysteroscopy in patients sedated with propofol, and it can prevent the occurrence of subclinical respiratory depression and severe hypoxia.

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Local anaesthesia for office hysteroscopy: A systematic review & meta-analysis

Cited by 21 publications

References 36 publications

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini‐hysteroscope?

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini‐hysteroscope?

Office versus Institutional Operative Hysteroscopy: An Economic Model

High-flow nasal oxygen reduces the incidence of hypoxia in sedated hysteroscopy for assisted reproduction

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