Randomized Trial of Oral Misoprostol Before Endometrial Biopsy

Crane, Joan; Craig, Catherine; Dawson, Lesa; O’Grady, Teresa; Bartellas, Elias; Hutchens, Donna

doi:10.1016/s1701-2163(16)34351-1

Cited by 9 publications

(10 citation statements)

References 16 publications

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“…Regardless of route of administration, no benefit was demonstrated, and there is possible harm given that misoprostol itself causes cramping. 31,32 Several trials demonstrated a modest benefit on pain with an intrauterine lidocaine infusion when compared with saline. 33,34 This is most commonly administered transcervically with a 91 Pain Management for Gynecologic Procedures • CME Review Article syringe attached to an angiocatheter, which is left in place between 3 and 5 minutes prior to endometrial biopsy to prevent backflow out of the cervical os.…”

Section: Endometrial Biopsymentioning

confidence: 99%

Pain Management for Gynecologic Procedures in the Office

Ireland¹,

Allen²

2016

Obstetrical &Amp; Gynecological Survey

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Section: Endometrial Biopsymentioning

confidence: 99%

Pain Management for Gynecologic Procedures in the Office

Ireland¹,

Allen²

2016

Obstetrical &Amp; Gynecological Survey

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“…Most patients can tolerate pain to complete necessary procedures but studies show that pain scores are often high.. Cervical biopsy and cervical curettage are associated with visual analogue scale (VAS) pain scores ranging from four to six on a 10-point scale. (1, 2) Endometrial biopsies done have VAS scores of five to seven(3, 4). Pain with intrauterine device (IUD )insertion varies from two to seven, (5–8) and pain scores during laminaria insertions with paracervical block range from five to seven.…”

Section: Introductionmentioning

confidence: 99%

Intrauterine Anesthesia for Gynecologic Procedures

Mercier

Zerden

2012

Obstetrics & Gynecology

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Objective To assess the effectiveness of intrauterine local anesthesia in reducing pain associated with outpatient gynecologic procedures. Data Sources We searched online databases PubMed or MEDLINE, Embase, Google Scholar, and Clinicaltrials.gov, and hand-searched reference lists from reviews evaluating pain control methods for gynecologic office procedures. We identified randomized controlled trials using intrauterine local anesthetic in gynecologic procedures. Methods Titles and abstracts were screened for 1,236 articles. We identified 45 potential articles for inclusion. We excluded 22 of these studies because: 1) they were not randomized controlled trials; 2) they did not describe a quantifiable dose of medication used in the study; 3) they did not investigate an intrauterine anesthetic; 4) they did not study a potentially awake, outpatient procedure; and 5) they did not clearly report results or represented duplicate publication. Twenty-three articles were ultimately included for review. Tabulation, Integration, and Results Two authors independently reviewed full search results and assessed eligibility for inclusion, and independently abstracted data from all articles that met criteria for inclusion. Disagreements regarding eligibility or abstraction data were adjudicated by a third independent person. Our primary endpoint was reported effect of intrauterine local anesthesia on patient-reported pain scores. Due to heterogeneity in study methods, outcome measures, and reporting of outcomes, results could not be combined in a meta-analysis. Good evidence supports use of intrauterine anesthesia in endometrial biopsy and curettage, as five good-quality studies reported reduced pain scores while only one good-quality study reported negative results. We found moderate evidence to support intrauterine anesthesia in hysteroscopy, as one good-quality study and two fair or poor quality studies reported reduced pain scores, while two good-quality studies had negative results. Good evidence suggests that intrauterine anesthesia is not effective in hysterosalpingography; three good-quality studies reported that pain scores were not reduced, and no good quality studies showed beneficial effect in that procedure. Evidence was insufficient concerning first-trimester abortion, saline-infusion sonogram, tubal sterilization, and intrauterine device insertion. Conclusion Intrauterine local anesthesia can reduce pain in several gynecologic procedures including endometrial biopsy, curettage, and hysteroscopy, and may be effective in other procedures as well.

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“…39 Twentysix studies met the inclusion criteria and were included in the review. [40][41][42][43][44] (Figure 1). The size of the included studies ranged from 40 to 308.…”

Section: Study Selectionmentioning

confidence: 99%

Methods of pain control during endometrial biopsy: A systematic review and meta‐analysis of randomized controlled trials

Charoenkwan

Nantasupha

2019

J of Obstet and Gynaecol

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Aim To review effectiveness of methods for reducing pain during endometrial biopsy. Methods PubMed, Scopus, Cochrane Central Register of Controlled Trials and https://ClinicalTrials.gov databases were searched for randomized controlled trials that examined effectiveness of pain control methods for endometrial biopsy. Risk of bias was assessed from sequence generation, allocation concealment, blinding, incomplete outcome data and selective outcome reporting. Heterogeneity was examined from forest plot, statistical tests of homogeneity, and I2 statistic. For meta‐analysis of pain scores, weighted mean difference with 95% confidence interval (CI) were estimated. Results Twenty‐six studies were included in the review. Marginally significant reduction in the pain score during the procedure in participants with intrauterine lidocaine relative to control was observed (mean difference [MD] −1.31, 95% confidence interval [CI] −2.70 to 0.09, P = 0.07). Subgroup analysis showed that in studies that used low‐pressure suction devices, intrauterine lidocaine was associated with statistically significant reduction in pain during the procedure (MD −2.22, 95% CI −3.72 to −0.73, P = 0.004). There was a significantly lower pain score during biopsy in the anesthetic spray group compared to control (MD −0.96, 95% CI −1.53 to −0.39, P = 0.001). Significant heterogeneity on types of intervention and outcome measures among studies that examined paracervical block and nonsteroidal anti‐inflammatory drugs (NSAID) was observed. However, paracervical block and NSAID were associated with significant pain reduction compared to placebo in most of the related studies. Conclusion Intrauterine anesthetics, anesthetic cervical spray, paracervical block and oral NSAID provide effective pain control during endometrial biopsy.

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Randomized Trial of Oral Misoprostol Before Endometrial Biopsy

Cited by 9 publications

References 16 publications

Pain Management for Gynecologic Procedures in the Office

Pain Management for Gynecologic Procedures in the Office

Intrauterine Anesthesia for Gynecologic Procedures

Methods of pain control during endometrial biopsy: A systematic review and meta‐analysis of randomized controlled trials

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