Pain assessment during outpatient hysteroscopy using room temperature versus warm normal saline solution as a distention medium – a prospective randomized study

T. Issat, J. Beta, M.A. Nowicka, A. Durczyński, A.J. Jakimiuk
2017 Clinical and experimental obstetrics & gynecology  
Outpatient hysteroscopy, also known as office hysteroscopy, is an established diagnostic tool [1] . The procedure involves miniaturised endoscopic device to visualise and examine the uterine cavity, without the need for operating room facilities or anaesthesia. It is indicated for the assessment of women with abnormal uterine bleeding [1] . Other common procedures include endometrial polypectomy [2], removal of small submucous fibroids [3], endometrial ablation [4], removal of lost intrauterine
more » ... devices, and transcervical sterilisation [5] or as a part of sub-fertility evaluation and management. One of the main causes of procedure failure is patient discomfort and pain. Advocated risk factors include nulliparity, cervical stenosis, chronic pelvic pain, anxiety, and menopause, as well as hysteroscope diameter, operative time, and characteristics of the intrauterine lesion (location, shape and size) [6, 7] . Pain from uterine cavity is driven by visceral afferent fibers with sympathetic fibers through the hypogastric nerves to the T12-L2 spinal ganglia [8] . Pain from the cervix and vagina is conducted by visceral afferent fibers to the S2-S4 spinal ganglia via the pudendal and pelvic splanchnic nerves, along with parasympathetic fibers [9] . Biopsy or destruction of endometrium may cause additional pain as a result of uterus contraction [10] . Some authors suggested that the pain during the procedure might be related to prostaglandin release as a result of the hysteroscope manipulation or uterine distention [11] . There is no consensus on the optimal method of pain reduction during outpatient hysteroscopy [12] with several different approaches being reported, including use of lidocaine gel [13], intravenous tramadol [14], intrauterine and intracervical lidocaine [15, 16] , mifepristone [17] or sublingual buprenorphine [18] . Additionally, results of some studies suggested that the outpatient hysteroscopy performed under moderate sedation might increase patient safety and satisfaction [19] . Results from previous studies showed that vaginal misoprostol administrated before the procedure reduced pain during and directly after the hysteroscopy, when compared to placebo or ketoprofen [20] . Recently published guidelines for clinical practice from the French College of Gynaecologists and Obstetricians recommended that office hysteroscopy should be per-
doi:10.12891/ceog3486.2017 fatcat:ogkakozhqbezzij3mzfl7mrcuy