Abstract
Objective
To evaluate the role of conscious sedation on pain control in office hysteroscopy.
Methods
MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception to the 30th October
2020 in order to perform a systematic review and meta-analysis of all randomized controlled
trials investigating women undergoing office hysteroscopic procedures, allocated to
either conscious sedation or a suitable comparator, where the outcome was pain. Data
regarding adverse events, feasibility and satisfaction/acceptability were also collected.
The Risk of Bias 2 tool was used to assess study quality. Standard mean differences
(SMD) or Odds Ratios (OR), and their 95% confidence intervals (CIs) were calculated
for continuous (e.g. mean pain) and dichotomous (e.g. side-effects) outcomes, respectively.
Results
The literature search returned 339 results, of which seven studies were included for
systematic review, with five studies having data suitable for meta-analysis. Intravenous
conscious sedation, when compared with local anesthesia, reduced pain during (SMD
−0.26, 95% CI −0.51 to −0.01), but not after (SMD −0.18, 95% CI −0.43 to 0.07) office
hysteroscopy. No significant difference in side-effects were noted (OR 15.58, 95%
CI 0.08 to 2891.91). Intravenous conscious sedation, when compared to an oral analgesic
and antispasmodic, was associated with increased pain, both during (SMD 1.03, 95%
CI 0.56 to 1.49) and after (SMD 0.49, 95% CI 0.04 to 0.93) hysteroscopy and had significantly
more side-effects (OR 134.33, 95% CI 16.14 to 1118.17). Inhalational conscious sedation
(70% N2O/30% O2), when compared to oral analgesia and anxiolysis, showed the greatest reduction in
pain during hysteroscopy (SMD −1.04, 95% CI −1.57 to −0.52), however side-effects
were not reported. Whilst patients and hysteroscopists were more satisfied with deeper
levels of sedation, resulting side-effects, such as delirium, increased the level
of post-procedural attention required, leading to a significantly lower level of satisfaction
amongst nursing staff.
Conclusion
The routine use of conscious sedation in contemporary hysteroscopic practice should
be avoided in the absence of any clear reduction in pain and a higher risk of side-effects.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pain relief for outpatient hysteroscopy.Cochrane Database of Systematic Reviews. 2017; https://doi.org/10.1002/14651858.cd007710.pub3
- Outpatient hysteroscopy: an observational study of patient acceptability.Medicina (Kaunas). 2004; 40: 1207-1210
- Pain management in outpatient hysteroscopy.Gynecology and Minimally Invasive Therapy. 2016; 5: 141-147https://doi.org/10.1016/j.gmit.2016.08.001
Clark TJ, Cooper NAM, Kremer C. Green-top Guideline No. 59 Best Practice in Outpatient Hysteroscopy. London: 2011.
- Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia.Quality Management and Departmental Administration, Committee of Origin2019
- A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons.American. Anesthesiology. 2018; 2018: 437-479https://doi.org/10.1097/ALN.0000000000002043
- Conscious sedation for pain control during outpatient hysteroscopy.International Prospective Register of Systematic Reviews, PROSPERO2019 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019138152)
Cochrane. Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020) 2020. www.training.cochrane.org/handbook (accessed November 1, 2020).
- RoB 2: a revised tool for assessing risk of bias in randomised trials.Br Med J. 2019; 366: 1-8https://doi.org/10.1002/14651858.CD201601
- Review Manager (RevMan) [Computer program]. 2014; 5.3
- Outpatient operative hysteroscopy with bipolar electrode: A prospective multicentre randomized study between local anaesthesia and conscious sedation.Hum Reprod. 2003; 18: 840-843https://doi.org/10.1093/humrep/deg075
- Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy.Indian J Med Sci. 2009; 63: 244-252https://doi.org/10.4103/0019-5359.53394
- Oral Analgesia vs Intravenous Conscious Sedation during Essure Micro-Insert Sterilization Procedure: Randomized, Double-Blind, Controlled Trial.Journal of Minimally Invasive Gynecology. 2011; 18: 108-111https://doi.org/10.1016/j.jmig.2010.10.006
- Nitrous oxide for pain management during in-office hysteroscopic sterilization: a randomized controlled trial.Contraception. 2017; 95: 239-244https://doi.org/10.1016/j.contraception.2016.09.006
- Evaluation of Paracervical Block and IV Sedation for Pain Management during Hysteroscopic Polypectomy: A Randomized Clinical Trial.Pain Res Manage. 2017; 2017: 1-7https://doi.org/10.1155/2017/5309408
- Comparison of sedation with dexmedetomidine vs propofol during hysteroscopic surgery: Single-centre randomized controlled trial.J Clin Pharm Ther. 2019; 44: 312-317https://doi.org/10.1111/jcpt.2019.44.issue-210.1111/jcpt.12793
- Low-dose ketamine for outpatient hysteroscopy: A prospective, randomised, double-blind study.Turkish Journal of Anaesthesiology and Reanimation. 2020; : 134-141https://doi.org/10.5152/TJAR.10.5152/TJAR.202010.5152/TJAR.2019.73554
- Vaginoscopy for office hysteroscopy: A systematic review & meta-analysis.European Journal of Obstetrics and Gynecology and Reproductive Biology. 2020; 252: 278-285https://doi.org/10.1016/j.ejogrb.2020.06.045
National Guideline Alliance (UK). Anaesthesia or sedation for surgical abortion: Abortion care: Evidence review N. NICE Guideline [NG140] 2019. https://doi.org/10.1007/9781107338623
- An Evaluation of Oral Midazolam for Anxiety and Pain in First-Trimester Surgical Abortion: A Randomized Controlled Trial.Obstet Gynecol. 2015; 126: 37-46https://doi.org/10.1097/AOG.0000000000000913
- Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial.Obstet Gynecol. 2009; 113: 276-283https://doi.org/10.1097/AOG.0b013e3181938758
- Safe Sedation Practice for Healthcare Procedures: Standards and Guidance.Academy of Medical Royal Colleges, London2013
Article info
Publication history
Published online: September 03, 2021
Accepted:
September 1,
2021
Received in revised form:
August 23,
2021
Received:
May 7,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
