Background: Outpatient hysteroscopy (OPH) is an important diagnostic and therapeutic intervention in gynaecology. However, the most common reason for failure is pain. Currently, there is no consensus regarding analgesia for OPH amongst the literature.
Objective: The aim of this systematic review was to assess the efficacy of pharmacological and non-pharmacological interventions for pain control during OPH.
Study Design And Methods: Randomised controlled trials (RCT) from January 2017 to February 2024 assessing efficacy of pharmacological and non-pharmacological methods for analgesia in OPH were included. MEDLINE, Embase and CENTRAL databases were used to search papers for inclusion. Two independent reviewers selected eligible studies for systematic review. The primary outcome was pain assessed via a subjective pain screening tool. Secondary outcomes included adverse events.
Results: 16 RCTs were included with the majority being 'low risk' of bias. Tramadol, vaginal misoprostol and cervical lidocaine flushing significantly reduced pain. Hyoscine-N-butyl Bromide (HBB) with diclofenac and lidocaine in distension media produced conflicting results. Oral misoprostol and diclofenac alone failed to show significant differences in pain scores. Regarding non-pharmacological interventions, vocal distraction, transcutaneous electrical nerve stimulation and video-based multimedia information all significantly reduced pain. The effect of warmed distension media and virtual reality for pain control is unclear. Only one study found the treatment group (HBB and diclofenac) was associated with significantly higher adverse events.
Conclusion: This study highlights potential use of both pharmacological and non-pharmacological methods as safe and effective forms of analgesia for OPH. We hope the results of this systematic review will help improve clinical practice and assist with developing future pain management protocols for OPH while also highlighting areas of interest for future research.
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