Carbon dioxide versus normal saline in outpatient hysteroscopy

Litta, Pietro; Bonora, M.; Pozzan, Chiara; Merlin, F.; Sacco, Giuseppe; Fracas, M; Capobianco, Giampiero; Dessole, Salvatore

doi:10.1093/humrep/deg465

Cited by 45 publications

(25 citation statements)

References 15 publications

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“…As reported by Shaid et al (34), different pressures of distension media are not significant variables. As previously stated by Litta et al (1) and Nagele et al (17), with normal saline the duration of the procedure is considerably shorter but is more painful.…”

Section: Discussionmentioning

confidence: 64%

“…Unlike other studies (1,15,17,27,29), we deemed it advisable to also exclude women who underwent an endometrial biopsy during the hysteroscopy. In 2007 de Carvalho Schettini et al (27) published a nonrandomized, observational study with a multivariate analysis examining the causes of pain in hysteroscopy, but the procedure was performed using two different hysteroscopes, the aid of a tenaculum, and with a biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…D iagnostic hysteroscopy is the gold standard in the study of uterine cavity morphology and in the diagnosis of endocavitary pathologies (1). Despite being considered an outpatient procedure (2) that is associated with a high success rate and a low complication rate (3), hysteroscopy is largely viewed as a painful procedure, poorly tolerated by patients (4) and often carried out under general or local anesthesia.…”

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confidence: 99%

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Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial

Mazzon

Favilli

Grasso

et al. 2014

Fertility and Sterility

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial

Mazzon

Favilli

Grasso

et al. 2014

Fertility and Sterility

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“…According to different authors, pain is the main limiting factor to the outpatient procedure and one of the causes of impaired accuracy of the exam, sometimes leading to unsatisfactory results (1,(4)(5) . In our study, the mean score of pain reported after the exam was considered moderate according to our grade of pain, that is, minimal pain (0 to 4), moderate (4.1 to 7) and severe (7.1 to 10) (7) . This score was higher than others published by some authors, probably because in all patients we used a 5-mm diameter optics and tenaculum as a standard research protocol (8) .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pain in outpatient diagnostic hysteroscopy with gas

Diniz

Depes

Santos

et al. 2010

Einstein (São Paulo)

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Objective: To evaluate the intensity of pain reported by patients undergoing outpatient diagnostic hysteroscopy. Methods: Exam performed with a 5-mm lens hysteroscope, vaginal speculum, tenaculum and uterine distention with carbon dioxide gas. Before and after the examination, patients were interviewed to define, in a verbal scale from 0 to 10, pain values that they expected to feel and that they experienced after the end, and also if they would repeat it if indicated. Data were analyzed using Statistical Package for the Social Sciences 15.0, statistic significance was defined as p < 0.05 with a study power of 95%. results: Fifty-eight patients were included with mean age of 50.9 years, with 32.8% at postmenopause and 6.9% nulliparous. Among those with previous deliveries, mean parity was 2.21 and at least one vaginal delivery had occurred in 63.8%. Only 24.1% of patients knew how the exam would be done, 62.1% needed an endometrial sample and the result was considered satisfactory in 89.7%. The means of expected and experienced pain were similar (6.0 versus 6.1), and 91.4% of women would repeat the hysteroscopy if necessary. The only factor associated with less pain after the exam was previous vaginal delivery, with a decrease of pain score from 7.1 to 5.5 (p = 0.03). Mean pain was significantly lower in those who agreed to repeat the exam (5.8 versus 9.4; p = 0.003). conclusions: Outpatient diagnostic hysteroscopy with gas can be associated with moderate but tolerable discomfort and satisfactory results.Keywords: Pain measurement; Pain measurement/diagnosis; Hysteroscopy/methods; Ambulatorial care; Outcome and process assessment (Health Care) reSUMO Objetivo: Avaliar a intensidade da dor referida pelas pacientes submetidas à histeroscopia diagnóstica ambulatorial. Métodos: Exame realizado com ótica de 5 mm, espéculo, pinçamento do colo com Pozzi e distensão da cavidade uterina com dióxido de carbono. Antes e depois do exame, as pacientes foram entrevistadas para definir, em uma escala verbal de 0 a 10, valores para espectativa de dor e dor experimentada após seu término, e também se elas o repetiriam se houvesse indicação. Os dados foram analisados no Statistical Package for the Social Sciences 15.0, com significância estatística definida como p < 0,05 e poder do teste de 95%. resultados: Foram incluídas 58 pacientes, com idade média de 50,9 anos, sendo 32,8% na pós-menopausa e 6,9% nulíparas. Dentre as pacientes com partos anteriores, a paridade média foi 2,21 e pelo menos um parto normal ocorreu em 63,8%. Apenas 24,1% das pacientes sabiam como o exame seria feito, 62,1% necessitaram de biópsia endometrial e o resultado foi considerado satisfatório em 89,7% dos casos. As médias de dor esperada e referida pelas pacientes foram semelhantes (6,0 versus 6,1), e 91,4% das mulheres repetiriam a histeroscopia quando necessário. O único fator associado à redução da dor após o exame foi o antecedente de parto normal, com queda de 7,1 para 5,5 (p = 0,03). A média de dor foi significativamente menor nas pacientes...

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“…Saline is equal (Litta et al 2003 ;Shankar et al 2004 ) or better (Pellicano et al 2003 ) in terms of patient discomfort and satisfaction and provides a superior view to CO 2 , as bubbles and bleeding impede the view more often when CO 2 is used (Litta et al 2003 ;Shankar et al 2004 ;Pellicano et al 2003 ). If the choice is made to convert to a see-and-treat procedure, saline has the advantage of compatibility with bipolar equipment allowing for immediate treatment.…”

Section: Distension Medium In Hysteroscopymentioning

confidence: 99%