Diclofenac versus a combination of hyoscine and diclofenac for outpatient hysteroscopy: A placebo controlled randomized clinical trial

Souza, Carlos Augusto Bastos de; Genro, Vanessa Krebs; Tarrasconi, Diego V.; Oppermann, Maria; Cunha-Filho, João Sabino

doi:10.1016/j.ejogrb.2020.01.030

Cited by 3 publications

(10 citation statements)

References 20 publications

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“…A PRISMA flow diagram of the study literature search is shown in Figure 1 . This study included an analysis of 291 patients from three studies ( 16 , 22 , 23 ). Of these 291, 144 (49.5%) received hyoscine, and 147 (50.5%) were in the placebo group.…”

Section: Resultsmentioning

confidence: 99%

“…Two of the studies ( 16 , 22 ) reported adequate allocation concealment, and therefore they were considered a low ROB. One study ( 23 ) did not report enough data about allocation concealment thus was considered to be an unclear ROB. All of the included studies were double-blinded and so were judged to be free from participant and personnel blinding bias.…”

Section: Resultsmentioning

confidence: 99%

“…All of the included studies were double-blinded and so were judged to be free from participant and personnel blinding bias. Two studies ( 16 , 22 ) were judged to be at a low ROB from failing to blind the outcome assessment, except Souza et al ( 23 ) which did not report sufficient details and so was considered an unclear ROB. Again, two studies ( 16 , 22 ) were judged to be at low risk of attrition bias, except Souza et al ( 23 ) which was found to be at high ROB, secondary to a lack of reporting sufficient details about the described outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Pooled analysis was heterogeneous (p=0.01; I 2 =76%) as shown in Figure 4A . We solved the heterogeneity by the exclusion of Souza et al ( 23 ) (p=0.69; I 2 =0%). The pooled analysis after exclusion of Souza et al ( 23 ) significantly favored the hyoscine group [MD: 0.26 (0.16, 0.43) (p<0.01)].…”

Section: Resultsmentioning

confidence: 99%

“…We solved the heterogeneity by the exclusion of Souza et al ( 23 ) (p=0.69; I 2 =0%). The pooled analysis after exclusion of Souza et al ( 23 ) significantly favored the hyoscine group [MD: 0.26 (0.16, 0.43) (p<0.01)]. Figure 4B shows the recalculated results of the analysis after one study was excluded ( 23 ).…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis

Marchand¹,

Kurdi²,

Sainz³

et al. 2022

J Turkish German Gynecol Assoc

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We conducted a systematic review and meta-analysis of relevant clinical trials from full-text, scientific journal archives to assess the efficacy of hyoscine for the management of pain during in-office hysteroscopy (OH) procedures. Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE, PubMed, SCOPUS and the Web of Science were searched for all clinical trials that matched our search criteria. A full assessment of bias was made using the Cochrane Group tool-set. The following outcomes were included: visual analogue scale (VAS) score for postoperative pain, postoperative need for analgesia, and procedure time. In the case of homogeneous data, the analysis was performed using a fixed effects system, and the random effects system was used with heterogeneous data. Inclusion criteria included only randomized clinical trials, and interventions that included patients receiving hyoscine-N-Butyl Bromide during OH, regardless of dose or mode of administration, and compared this with placebo. Three clinical trials were included. The actual mean difference (MD) of the VAS pain score showed no significant difference between hyoscine or placebo [MD: -0.28 (-1.08, 0.52), (p=0.49)]. For postoperative analgesia, the overall MD showed no significant difference between hyoscine or placebo [MD: 0.43 (0.16, 1.14), (p=0.09)]. For procedure time, the combined effect estimate failed to show any significant difference between hyoscine and placebo [MD: -0.66 (-2.77, 1.44) (p=0.54)]. Contrary to previously published data, our meta-analysis using the latest available RCTs fails to show hyoscine as being effective in reducing pain or the need for other forms of anesthesia in OH.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis

Marchand¹,

Kurdi²,

Sainz³

et al. 2022

J Turkish German Gynecol Assoc

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Outpatient Hysteroscopy

De Silva,

Smith,

Cooper

et al. 2024

BJOG

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Key recommendations All gynaecology departments should provide a dedicated outpatient hysteroscopy service to aid care of women and people with abnormal uterine bleeding, reproductive problems, and insertion/retrieval of intrauterine devices. [Grade A] Written information should be provided to the woman prior to their appointment. This should include details about the procedure, the benefits and risks, advice regarding pre‐operative analgesia, as well as alternative options for care and contact details for the hysteroscopy unit. [Good Practice Point] Women should be made aware of other settings and modes of anaesthesia for hysteroscopy (e.g. under general or regional anaesthesia or intravenous sedation). [GPP] The woman should be advised that if they find the procedure too painful or distressing at any point, they must alert the clinical team who will stop the procedure immediately. The clinical team should alert the hysteroscopist if the woman appears to be in too much pain or is experiencing a vasovagal episode and therefore unable to voice the concerns so that the procedure can be stopped. [GPP] Women should be advised to take standard doses of oral non‐steroidal anti‐inflammatory agents (NSAIDs) one hour before their scheduled appointment. Vaginoscopy should be the standard technique for outpatient hysteroscopy unless the use of a vaginal speculum is required (e.g. for administering local cervical anaesthesia or dilating the cervix). [Grade A] When performing operative hysteroscopy, the smallest diameter hysteroscope should be used, with consideration given to the use of hysteroscopes with expandable outer working channels because they are associated with less pain. [Grade B] Mechanical hysteroscopic tissue removal systems should be preferred over miniature bipolar electrodes to remove endometrial polyps. [Grade A] Local anaesthesia should not be routinely administered prior to outpatient hysteroscopy where a vaginoscopic approach is used. It should be considered where use of a vaginal speculum is planned e.g. for cervical dilatation if anticipated, due to either cervical stenosis and/or the utilisation of larger‐diameter hysteroscopes (≥5mm outer diameter). [Grade A] Saline should be instilled at the lowest possible pressure to achieve a satisfactory view. [Grade A] Conscious sedation should not be routinely used in outpatient hysteroscopic procedures. [Grade B]

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Pain Management during Office Hysteroscopy: An Evidence-Based Approach

Buzzaccarini

Pacheco²,

Vitagliano

et al. 2022

Medicina

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Background and Objectives: Hysteroscopy is a reliable technique which is highly useful for the evaluation and management of intrauterine pathology. Recently, the widespread nature of in-office procedures without the need for anesthesia has been requesting validation of practical approach in order to reduce procedure-related pain. In this regard, we performed a comprehensive review of literature regarding pain management in office hysteroscopic procedures. Materials and Methods: MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Global Health, Health Technology Assessment Database and Web of Science, other research registers (for example Clinical Trials database) were searched. We searched for all original articles regarding pain relief strategy during office hysteroscopy, without date restriction. Results have been collected and recommendations have been summarized according to the Appraisal of Guidelines for Research and Evaluation (AGREE) tool. Moreover, the strength of each recommendation was scored following the Grading of Recommendations Assessment (GRADE) system, in order to present the best available evidence. Results: Both pharmacological and non-pharmacological strategies for pain management are feasible and can be applied in office setting for hysteroscopic procedures. The selection of strategy should be modulated according to the characteristics of the patient and difficulty of the procedure. Conclusions: Accumulating evidence support the use of pharmacological and other pharmacological-free strategies for reducing pain during office hysteroscopy. Nevertheless, future research priorities should aim to identify the recommended approach (or combined approaches) according to the characteristics of the patient and difficulty of the procedure.

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Diclofenac versus a combination of hyoscine and diclofenac for outpatient hysteroscopy: A placebo controlled randomized clinical trial

Cited by 3 publications

References 20 publications

Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis

Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis

Outpatient Hysteroscopy

Pain Management during Office Hysteroscopy: An Evidence-Based Approach

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