Original article
A Randomized Trial of Outpatient Hysteroscopy with and without Intrauterine Anesthesia

Presented at the 36th Global Congress of Minimally Invasive Gynecology, Washington, D.C., November 13–17, 2007 (Third-place Golden Hysteroscope Award).
https://doi.org/10.1016/j.jmig.2008.01.013Get rights and content

Abstract

Study Objective

To evaluate the amount of pain during office hysteroscopy and endometrial biopsy with and without intrauterine anesthesia.

Design

Prospective randomized study (Canadian Task Force classification I).

Setting

Academic teaching center.

Patients

A total of 82 women underwent outpatient hysteroscopy for evaluation of their uterine cavity.

Interventions

Randomization to local cervical or combined cervical and intrauterine anesthesia.

Measurements and Main Results

Amount of pain experienced during the procedure; 10, 30, and 60 minutes after the procedure; and during endometrial biopsy. We used a visual analog scale ranging from 0 to 10 (0: no pain, 10: excruciating pain). Of 82 patients, 4 patients were excluded, 36 patients underwent hysteroscopy using local cervical anesthesia, and 42 others with combined cervical and intrauterine anesthesia. The mean age of the patients in the local group was 37.4 ± 0.8 years and in the combined group was 38.3 ± 0.7 years. In both groups, patients experienced significantly more pain during and 10 minutes after the procedure than 30 and 60 minutes after. No significant differences occurred in the pain scores during the hysteroscopy, and 10, 30, and 60 minutes after between the 2 anesthesia groups. The pain score in the local group during endometrial biopsy was significantly higher than during (p <.05), 10 minutes after (p <.001), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure, respectively. In the combined group, compared with the pain score during endometrial biopsy, the scores during the hysteroscopy (p <.05), 10 minutes after (p <.01), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure were also less, respectively.

Conclusion

Intrauterine anesthesia with medicated saline as a distending medium is ineffective. Endometrial biopsy is associated with more pain than hysteroscopy.

Section snippets

Materials and Methods

Between August 2006 and June 2007, 82 infertile women undergoing outpatient hysteroscopy were randomized into hysteroscopy using local cervical anesthesia or combined cervical and intrauterine anesthesia. Randomization was done using a computer-generated random table. The hospital research ethics board approved the study. Study participants were counseled, and informed consent was obtained before randomization.

Following our standard practice, all patients were given an anxiolytic (lorazepam 10

Results

Of 82 patients recruited, 4 were excluded from the analysis (2 from each group). Three patients withdrew their consent and another could not tolerate speculum examination. As a result, 36 patients were in the local cervical group and 42 patients in the combined cervical and intrauterine group. In all cases, cervical dilatation was not required and the hysteroscope was introduced only once.

Profiles of the patients in the 2 groups were comparable (Table 1). Patients experienced significantly more

Discussion

Hysteroscopy is an important tool to evaluate the uterine cavity. In our infertile population, most patients had normal uterine cavity. As patients with abnormal sonohysterography results had been excluded before hysteroscopy, our findings are expected. In the past few years, we also performed endometrial biopsy immediately after the completion of hysteroscopy examination. Those with chronic endometritis on histopathology are treated with antibiotics before undergoing treatment with in vitro

References (10)

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    Citation Excerpt :

    For this reason, numerous studies have evaluated the effectiveness of alternative solutions in an attempt to make the investigation less painful. These include the use of normal saline instead of carbon dioxide (CO2) [5], the use of small-calibre [6] or flexible [7] hysteroscopes, a vaginoscopic approach [8], the administration of prostaglandins to induce cervical dilation [9], and recourse to analgesia [10] or local anaesthesia [11]. Some studies have sought to identify the variables responsible for pain during diagnostic hysteroscopy [12–14], but none of them has studied the correlation between pain and the characteristics of the cervix, particularly the morphology of the cervical canal.

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The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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