Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis

Abstract

Objective: To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). Design: Systematic review and network meta-analysis of randomized controlled trials. Setting: Not applicable. Patient(s): Pre-or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. Intervention(s): We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). Main Outcome Measure(s): The intensity of pain during, immediately after, and 10-30 minutes after procedure assessed by the 10-cm visual analog scale. Result(s): Lidocaine spray was the most effective medication for reducing pain during OEB (P-score ¼ 0.83) and immediately after OEB (P-score ¼ 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score ¼ 1.00), followed by misoprostol plus lidocaine (P-score ¼ 0.87). Conclusion(s):Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA. (Fertil Steril Ò 2019;112:140-8. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

A virtual reality system for pain and anxiety management during outpatient hysteroscopy—A randomized control trial

“…The pain scores were usually assessed within 30 min form the end of the procedure. In one study (Floris et al, 2007), tramadol was associated with a significant less pain at the end of the procedure than women who received no medication (p < 0.001), while in other studies (Abbas et al, 2019;Dahlberg et al, 1979;Lin et al, 2005;Malloy & Milling, 2010), there was no significant post-operative pain reduction with the use of buprenorphine 50 mg, oral diclofenac and other agents prescribed 50-60 min prior to the hysteroscopy. Data regarding the effect of nonpharmacological post-operative pain relief are limited as the use of nitrous oxide in a non-randomized study (Del Valle Rubido et al, 2015) and transcutaneous electrical nerve stimulation (TENS) was previously reported (Lisón et al, 2017) to reduce pain during and after office hysteroscopy without sedation.…”

“…These procedures are usually well tolerated by patients, but they can be associated with some amount of pain and anxiety (Ahmad et al, 2010;Allen et al, 2013;De Silva et al, 2020). Furthermore, patients frequently experience physical and emotional stress before undergoing these procedures, which may be exacerbated by some prevalence of pain during the procedure (Abbas et al, 2019;Reddy & Wasserman, 1997).…”

“…A variety of approaches are employed in office hysteroscopy for pain reduction (De Silva et al, 2020), among them opioid and non-opioid analgesia and Transcutaneous Electrical Nerve Stimulation (TENS). Pre-medication with opiate or non-opiate drugs was reported to be associated with post-operative pain improvement (Abbas et al, 2019;Okifuji & Ackerlind, 2007;Reddy & Wasserman, 1997), while a large meta-analysis suggested that pre-treatment with analgesics had only a mild impact on patient pain scores, and conversely, an increase in side effects (Ahmad et al, 2010).…”

The effect of preoperative intravenous lidocaine on postoperative pain following hysteroscopy

“…[ 20 ] This is concordant with a recent meta-analysis that reported lidocaine paracervical block was the most effective method for reducing pain after outpatient hysteroscopy under local anesthesia. [ 21 ] While the systemic effects of lidocaine might act in a similar way to local anesthesia, the exact mechanism remains largely elusive. The analgesic effects of lidocaine, especially in terms of suppressing increased sensitivity to pain, were proven clinically.…”

Endometriyal biopsi işlemi öncesinde kullanılan oral Hyosine N Butil Bromur’ün analjezik etkinliği

“…Endometriyal biyopsi her ne kadar minimal invaziv ve günübirlik bir girişim olsa da, işlem sırasında hastalar orta-şiddetli seviyede ağrı hissetmekte ve işlem öncesinde analjezi gerekliliği ortaya çıkmaktadır (13). Bu amaçla sinirsel iletiyi azaltan veya bloke eden ajanlarla birçok çalışma yapılmıştır.…”