Abstract
Hysteroscopy, hysterosalpingography (HSG), sonohysterography and endometrial ablation
are increasingly performed in an outpatient setting. The primary reason for failure
to complete these procedures is pain. The objective of this review was to compare
the effectiveness and safety of different types of pharmacological intervention for
pain relief in office gynaecological procedures. A systematic search of medical databases
including PubMed, EMBASE, Cochrane Central register of controlled trials, PsychInfo
and CINHAL was conducted in 2009. Randomised controlled trials (RCTs) investigating
the use of local anaesthetics, opioid analgesics, non-opioid analgesics and intravenous
sedation for pain relief during and after hysteroscopy, HSG, sonohysterography and
endometrial ablation were reviewed. Secondary outcomes included adverse effects and
failure to complete procedures. Where RCTs were not identified, the best available
evidence was sought. Each study was assessed against inclusion criterion. Results
for each study were expressed as a standardised mean difference (SMD) with 95% confidence
intervals and combined for meta-analysis with Revman 5 software. Meta-analysis revealed
beneficial effect of the use of local anaesthetics during and within 30 min after hysteroscopy; SMD −0.45 (95% CI −0.73, −0.17) and SMD −0.51 (95% CI −0.81,
−0.21) respectively. No beneficial effect was noted during HSG. One RCT found evidence
of benefit for pain relief during hysterosalpingo-contrastsonography; SMD −1.04 [95%
CI −1.44, −0.63]. There was no significant difference in failure to complete hysteroscopy
due to cervical stenosis between the intervention and control groups (OR 1.31 (95%
CI 0.66, 2.59)), but the incidence of failure to complete the procedure due to pain
was significantly less in the intervention group (OR 0.29 (0.12, 0.69)). There is
evidence of benefit for the use of local anaesthetics for outpatient hysteroscopy
and hysterosalpingo-contrastsonography. Local anaesthetics may be considered when
performing hysteroscopy in postmenopausal women to reduce the failure rate.
Key words
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Article info
Publication history
Published online: December 16, 2010
Accepted:
November 26,
2010
Received in revised form:
October 21,
2010
Received:
July 5,
2010
Identification
Copyright
© 2011 Published by Elsevier Inc.
