Analgesic Efficacy of Intrauterine Lidocaine Flushing in Hysterosalpingo-foam Sonography: A Double-blind Randomized Controlled Trial

Abstract

To evaluate the efficacy of flushing the uterine cavity with lidocaine before hysterosalpingo-foam sonography (HyFoSy) to reduce procedure-related pain. Design: A double-blind randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Shamir Medical Center, Israel between June 2020 and September 2020 involving 80 women undergoing a HyFoSy procedure. Setting: University-affiliated medical center. Patients: A total of 40 women were assigned randomly to the lidocaine group and 40 to the saline (placebo) group using a predetermined randomization code. Intrauterine instillation before the procedure consisting of either lidocaine 2% or normal saline alone was conducted, respectively. Interventions: The primary outcome measure was the visual analog scale (VAS) pain score during the phase of intrauterine foam instillation reported by the women after the procedure. The VAS consisted of a 10-cm line ranging from 0 to 10 (anchored by 0 = no pain and 10 = very severe pain). On the basis of the VAS scores, the pain level ratings were classified as mild (rated 1−3), moderate (4−6), or severe (7−10). Measurements and Main Results: The patient characteristics and obstetric data were found to be similar in both groups. Comparison of the VAS pain scores experienced during the procedure showed that women in the lidocaine flushing group rated the procedure less painful than the women in the saline group (3.0 § 1.3 vs 6.3 § 1.5, respectively; p = .001). The incidence of severe pain was significantly lower in the lidocaine group than the saline group (2.5% and 45.0%, respectively, p = .001). Conclusion: Lidocaine flushing of the uterine cavity before HyFoSy significantly decreased the pain known to be caused by this procedure and had the advantage of no side effects. It is easily applied, relatively inexpensive, and may affect compliance with this procedure.

Evaluating the Effectiveness of Pharmacological Strategies and Further Measures for Pain Relief during Hysterosonosalpingography: A Systematic Review

“…Indication to the diagnostic procedure: six studies focused on infertile women [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. The remaining four studies [ 21 , 22 , 23 , 24 ] included women referred to their institutions for different reasons.…”

“…Specifically, in the study by Guney et al [ 15 ], patients were suffering from infertility, menometrorrhagia or postmenopausal bleeding. Melcer et al and Nirmal et al [ 16 , 17 ] included infertile women. Spieldoch et al [ 18 ] included women with infertility, recurrent miscarriage and abnormal uterine bleeding.…”

“…Melcer et al studied tubal patency and endometrial cavity too. A preliminary pelvic examination was performed digitally [ 19 , 22 ], with B-mode transvaginal ultrasound [ 16 , 18 , 20 , 21 ] or with 3D transvaginal ultrasound [ 24 ], while two studies did not report any baseline examination [ 15 , 23 ]. Amhadi et al and Yung et al used a 3D ultrasound for evaluating intrauterine abnormalities, Ozkan et al used a 4D examination.…”

New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records

“…Based on these findings, Moore et al advocated using no worse than mild pain as an outcome, defined as NRS (0–10) ≤3 or VAS (0–100) ≤30, which was better correlated with other pain-related symptoms such as insomnia and depression and more precisely reflected analgesic requirements in clinical practice ( Moore et al, 2013a ; Moore et al, 2013b ). Similarly defined moderate-to-severe pain has been used as an important parameter in population studies and clinical trials ( Bulilete et al, 2019 ; Melcer et al, 2021 ). Second, while opioid consumption was compared in MME, the conversion factors were controversial, with manual selection introducing bias ( Anderson et al, 2001 ).…”

A comprehensive use of ultrasound examination in infertility workup

“…Prophylactic analgesia is unnecessary, however, it is nevertheless considered, indomethacin trans-rectally and paracetamol or codeine orally seems to be effective [33,34]. Lately, intrauterine lidocaine flushing before HyFoSy has been proven to decrease the pain during the procedure [35]. In a study of 632 women who underwent HyCoSy, no late complications were observe.…”