Evaluation of pain in outpatient diagnostic hysteroscopy with gas

Abstract

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...

Comparative study of pain perception in outpatient hysteroscopy analyzing previous orientation by multimedia

“…[17][18][19][20]22,27 According to Dinz et al the test could be more tolerable if the patients were instructed in a more detailed way, which was supposed to reduce the anxiety and the expectation regarding the procedure, being this the main hypothesis of the study. 13 On one hand, the present study showed that the more well-oriented patients presented slightly more pronounced pain rates, when the analysis was made with the percentage. On the other hand, if the categorization had been according to the averages of pain, the result could be different, which may be a justification for the difference of results between groups.…”

“…Comparative study of pain perception in outpatient hysteroscopy analyzing previous orientation by multimedia account by the doctor. 13,23,24 It is of extreme importance the concern with the tolerance and the discomfort made by the procedure, which many time are not taken into account. [17][18][19][20]22,27 According to Dinz et al the test could be more tolerable if the patients were instructed in a more detailed way, which was supposed to reduce the anxiety and the expectation regarding the procedure, being this the main hypothesis of the study.…”

“…[10][11][12] Pain and discomfort are the main cause of hysteroscopy failure, which may limit or interrupt the evaluation and even frustrate the patient's return to future controls. 8,10,13 About 30% of patients undergoing this procedure without any type of anesthesia refer to feel severe pain, and the procedure performed with saline 0.9% was less painful than the technique with CO2. 14,15 The attempts to reduce pain using local anesthesia are usually unsuccessful, sometimes being considered more painful than the procedure itself.…”

“…22,23 Because of that, one hypothesis is that if patients would have a greater clarification about the examination, they could have a reduction of anxiety and even perceive a lower discomfort during hysteroscopy. 13,24 In this sense, this study aims to evaluate the impact of previous guidance on ambulatory hysteroscopy using multimedia resources (film), in comparison with only verbal orientations, in the intensity of perceived pain by the patient during the procedure without anesthesia.…”