Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial

Mazzon, Ivan; Favilli, Alessandro; Grasso, Mario; Horvath, Stefano; Bini, Vittorio; Renzo, Gian Carlo Di; Gerli, Sandro

doi:10.1016/j.fertnstert.2014.07.1249

Cited by 28 publications

(28 citation statements)

References 38 publications

(64 reference statements)

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“…There are a lot of studies comparing the effectiveness of different methods in reducing pain during hysteroscopy (e.g., lower intrauterine pressure, bladder-filling procedure, heated saline; electricity, music or hypnosis). However, there are evident discrepancies between the presented results [24][25][26].…”

Section: Discussionmentioning

confidence: 66%

Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures

Biela¹,

Doniec²,

Szafarowska³

et al. 2020

wiitm

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Introduction: Hysteroscopy is the gold standard for diagnosis and treatment of uterine pathologies. The office setting seems to be safe, reducing the anesthesia risks and also decreasing the overall costs of the procedure. Recent literature suggests that hysteroscopy performed without anesthesia may not be as painless as it was previously considered. Moreover, not every patient can be referred for a hysteroscopy in an office setting. Aim: To analyze the factors correlated with a successful hysteroscopy in an office setting. Material and methods: We analyzed the documentation of 1301 patients who underwent hysteroscopy at our department in the period 2013-2016. The impact of the type of the procedure and the various demographic factors on the need for general anesthesia was assessed. Results: Almost 80% of all hysteroscopies were performed without analgesia in an office setting. The remaining patients underwent a hysteroscopy in general anesthesia. The key aspect for successful office hysteroscopy is the scope of the performed surgery. Over 91% of diagnostic hysteroscopies have been done without analgesia, but only about 30% of extensive endometrial scratching procedures were performed in an office setting. A previous vaginal delivery increases the chances for a successful office hysteroscopy by about 21%, and in the case of diagnostic procedures, multiparous patients were at an about 79% lower risk of analgesia necessity. Conclusions: It is possible to perform nearly all diagnostic hysteroscopies in an office setting. In the case of operative hysteroscopy, the most crucial factor is the scope of the procedure.

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Section: Discussionmentioning

confidence: 66%

Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures

Biela¹,

Doniec²,

Szafarowska³

et al. 2020

wiitm

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show abstract

“…13 We attempted to control for as many factors related to pain during the procedure as possible. In this study, all the surgeries were performed by one surgeon using the same instrument, and there was also no difference in the baseline characteristics of the patients in the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

A Prospective, Randomized Comparison of Intramuscular Phloroglucinol Versus Oral Misoprostol for Cervix Pretreatment Before Diagnostic Hysteroscopy

Zhang

2015

International Surgery

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The aim of this study was to compare the effectiveness and safety of intramuscular phloroglucinol and oral misoprostol for cervix pretreatment before diagnostic hysteroscopy. Several modalities for cervical priming and pain reduction have been adopted to reduce the complications related to cervical dilatation before hysteroscopy. Among them, the prostaglandin analog misoprostol is the most frequently used agent. Phloroglucinol, a spasmolytic, has also been showed to have an effect in inducing cervical dilatation but is rarely used before hysteroscopy. One hundred twenty outpatients undergoing anesthesia-free diagnostic hysteroscopy were randomly assigned to receive 80 mg intramuscular phloroglucinol and 400 mg oral misoprostol before diagnostic hysteroscopy. The main outcome measures were preoperative cervical width, visual analog scales (VAS) for pain, cervical passage time, and adverse reactions. Intramuscular phloroglucinol resulted in a significantly wider cervical width, lower VAS pain score, shorter cervical passage time, and a lower adverse effects rate compared with oral misoprostol. Intramuscular phloroglucinol is more effective and safer than oral misoprostol in inducing proper cervical priming and may be the optimal choice for cervical pretreatment before diagnostic hysteroscopy.

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“…Factors arising from both the cervical canal itself (e.g. detachment) and also from the diameter of the hysteroscope can increase pain when passing through the cervical canal [18,25,26,27]. In this study, cases with cervical narrowness of a degree that would require dilatation or cases with detachment were not included.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Intrauterine Lidocaine and Rectal Indomethacin on Pain during Office Vaginoscopic Hysteroscopy: Randomized Double-Blind Controlled Study

Şentürk¹,

Güraslan²,

Babaoğlu³

et al. 2015

Gynecol Obstet Invest

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Backgrounds/Aims: The aim of this study was to investigate the effect of rectal and intrauterine anesthesia during vaginoscopic hysteroscopy. Methods: This was a randomized, double-blind, placebo-controlled study. Patients were randomized to rectal indomethacin, intrauterine lidocaine and placebo groups. Patients with conditions that could cause or contribute to pelvic pain were excluded. Pain was evaluated with Visual Analog Scale, when the cervical canal was passed, while within the cavity and at 10 min after procedure. The Analog Pain Scale scores of the 3 groups were compared with the Kruskal-Wallis 1-way analysis of variance test. A value of p < 0.05 was accepted as statistically significant. Results: The study included a total of 206 patients. No difference was seen between the groups in respect of indication, age, gravid and duration of procedure. While the anesthesia was determined as superior to the placebo in reducing pain at all 3 stages (p < 0.05), intrauterine lidocaine was determined to be more effective than rectal indomethacin in reducing pain within the cavity and 10 min after the procedure (p < 0.05). Conclusion: Rectal or intrauterine anesthesia applied with the vaginoscopic technique is useful in hysteroscopy. However, intrauterine anesthesia is more effective in reducing pain.

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Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial

Cited by 28 publications

References 38 publications

Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures

Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures

A Prospective, Randomized Comparison of Intramuscular Phloroglucinol Versus Oral Misoprostol for Cervix Pretreatment Before Diagnostic Hysteroscopy

The Effect of Intrauterine Lidocaine and Rectal Indomethacin on Pain during Office Vaginoscopic Hysteroscopy: Randomized Double-Blind Controlled Study

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