Evaluation of Paracervical Block and IV Sedation for Pain Management during Hysteroscopic Polypectomy: A Randomized Clinical Trial

Abstract

Background The aim of this study was to compare the effectiveness of paracervical block (PB) and IV sedation (IVS) on women's pain perception during operative hysteroscopy. Methods A total of 84 patients with uterine polyps were randomized to either PB or IV sedation or general anesthesia (GA) as control group. In PB group, the patients received oral diazepam 10 mg and 100 mg diclofenac Na suppository 60 min before surgery and 10 cc of 2% buffered lidocaine was injected at cervix. Conscious sedation was performed with the IV administration of 2-3 mg/kg/h propofol 1% and midazolam 0.02 mg/kg and fentanyl (1-2 μg/kg) with o2 4-5 lit/min via face mask. Results There were no significant differences between groups on VAS score at 3 hours after operation (PB: 1.22 ± (1.31), IVS: 1.10 ± (1.68), GA: 1.29 ± (2.03), P = 0.671) and during recovery (PB: 0.85 ± (1.06), IVS: 0.68 ± (1.33), GA: 1.21 ± (2.04), P = 0.458). There was no difference between PB (3.33 ± (2.81)) and IVS (2.31 ± (2.63)) groups at hysteroscopy (P = 0.182). Patients undergoing IVS reported lower VAS score than PB group at dilation and curettage, although the difference was not statistically significant (PB: 2.59 ± (1.78), IVS: 1.72 ± (2.34), P = 0.051). Moreover, patients undergoing IVS obtained lower VAS score than PB group at polypectomy, while the difference was not statistically significant (PB: 1.81 ± (1.52), IVS: 1.10 ± (1.32), P = 0.073). Conclusion The finding of the present study revealed that IVS and PB showed the same effect in reducing pain during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial with the number IRCT2016031426855N3, on April 28, 2016.

Dexmedetomidina intranasal en sedación para ginecoobstetricia

“…Se analizó los resultados de ambos grupos de estudio en cuanto a las características demográficas, la edad media en ambos grupos fue de 32 ± 7 años, no significativo En cuanto al IMC, en el grupo sin dexme es de 28 ± 6 kg/ cm 2 mientras que el grupo con dexme es de 27 ± 3 kg/cm 2 , no significativo.…”

“…Palabras clave: Dexmedetomidina, administración intranasal, sedación profunda, legrado L a dilatación y legrado uterino es un procedimiento común en obstetricia y ginecología, con estancia y alta hospitalaria corta 1 . Los métodos más comunes para reducir el dolor durante la dilatación cervical y las intervenciones uterinas son el bloqueo paracervical y la sedación 2 .…”

Procedural sedation and analgesia versus general anesthesia for hysteroscopic myomectomy (PROSECCO trial): A multicenter randomized controlled trial

“…Their overall anesthetic complication rate (3.5%), however, was comparable to our results (PSA group 4.7%, GA group 4.0%). Only a few other studies report on use of PSA with propofol for gynecologic surgery, including hysteroscopic polypectomies[ 3 , 6 ], thermal balloon ablation[ 23 ], vaginal prolapse surgery[ 27 , 29 ], and laparoscopic procedures (mainly salpingo-oophorectomies and laser ablation of endometriosis) [ 28 ]. Since these procedures are different from our study, it is difficult to compare completeness rates.…”

Procedural Sedation and Analgesia in Adults - new trends in patients safety

“…In more invasive procedures (therapeutic hysteroscopy), conscious sedation can be used in combination with a paracervical block, providing better post-procedural analgesia and a shorter recovery time than general anesthesia. Regional and general anesthesia should be reserved for interventions with extensive intrauterine manipulation [57][58][59].…”