Inhalation Analgesia With Nitrous Oxide Versus Other Analgesic Techniques in Hysteroscopic Polypectomy: A Pilot Study

Rubido, Cristina del Valle; Calvo, Juan Antonio Solano; Rodríguez‐Miguel, Antonio; Espeja, Juan José Delgado; Hinojosa, Jerónimo González; Goñí, Álvaro Zapico

doi:10.1016/j.jmig.2015.01.005

Cited by 21 publications

(7 citation statements)

References 24 publications

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“…In one study (Floris et al, 2007), tramadol was associated with a significant less pain at the end of the procedure than women who received no medication (p < 0.001), while in other studies (Abbas et al, 2019;Dahlberg et al, 1979;Lin et al, 2005;Malloy & Milling, 2010), there was no significant post-operative pain reduction with the use of buprenorphine 50 mg, oral diclofenac and other agents prescribed 50-60 min prior to the hysteroscopy. Data regarding the effect of nonpharmacological post-operative pain relief are limited as the use of nitrous oxide in a non-randomized study (Del Valle Rubido et al, 2015) and transcutaneous electrical nerve stimulation (TENS) was previously reported (Lisón et al, 2017) to reduce pain during and after office hysteroscopy without sedation. However, the post-operative effect was measured only until 5 min after the procedure.…”

Section: Discussionmentioning

confidence: 99%

A virtual reality system for pain and anxiety management during outpatient hysteroscopy—A randomized control trial

Fouks

Kern

Cohen

et al. 2021

European Journal of Pain

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Background: Visual and acoustic virtual reality (VR) has been increasingly explored as a non-pharmacological tool for pain relief in clinical settings.Objective: We aimed to evaluate the effectiveness of VR as a distraction technique in the management of acute pain during operative hysteroscopy in the outpatient setting. Methods:A prospective, open-label, randomized control trial in a tertiary university-affiliated medical centre between April and August 2020. Overall, 82 women were randomly allocated to undergo operative hysteroscopy either with the use of VR (n = 44, study group) or with standard treatment (control group, n = 38). VR was applied throughout the procedure and no anaesthesia was given. The primary outcome measures included self-reported intraoperative pain. Other objectives included vital parameters as pulse rate (PR) and respiratory rate (RR) before and during the first 3 min of the procedure. Pain and anxiety outcomes were measured as numeric rating scores. Results:The baseline parameters were similar between groups. The mean duration for the procedure was 8.1 ± 3.2 vs. 7.3 ± 6.0 min for the study and the control groups (p = 0.23). There were no statistically significant differences between the reported pain scores during the procedure [median (interquartile range) 5.0 (3.0-7.2) vs. 5.0 (3.0-8.0), respectively; p = 0.67]. While neither intraoperative heart rate nor respiratory rate differed between groups [14.0 (13.0-16.0) vs. 14.0 (11.0-16.5); p = 0.77)], the increase of heart rate was found greater in the VR group [+7.0 (8.5) vs. +1.0 (12.2); p = 0.01]. Conclusion:VR was not effective in reducing pain during an outpatient operative hysteroscopy.Significance: The use of a Virtual reality system was found ineffective in reducing pain during and after an office operative hysteroscopy without anaesthesia, in a thorough examination of both continuous physiological parameters and women's self-reported measures.This accompanies the following article: Dualé, C & Mourgues, C. The price of pain relief, or should non-invasive medical devices be treated differently in analgesic clinical trials?.

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Section: Discussionmentioning

confidence: 99%

A virtual reality system for pain and anxiety management during outpatient hysteroscopy—A randomized control trial

Fouks

Kern

Cohen

et al. 2021

European Journal of Pain

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“…Nevertheless, our finding seems in agreement with that reported by Schneider et al [ 8 ], who demonstrated that among 72 women (36 per study arm), nitrous oxide significantly decreased pain with in-office hysteroscopic sterilization compared to oral sedation, and they suggested that nitrous oxide can be an effective pain management option for such a procedure. Likewise, Del Valle Rubido et al [ 7 ] showed that nitrous oxide is a safe and effective analgesic technique for polypectomy office hysteroscopy compared with the paracervical infiltration and control groups. In the literature review, however, contradictory findings have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, studies on nitrous oxide for pain relief in gynecologic procedures have been published in a very limited number. Del Valle Rubido et al [ 7 ] demonstrated in their pilot study that nitrous oxide was a safe and effective analgesic technique for polypectomy office hysteroscopy compared with the paracervical infiltration and control groups. Accordingly, we conducted this randomized controlled trial aimed to compare the analgesic effectiveness of the patient-controlled inhaled nitrous oxide (Entonox ® ) with intravenous opioids (pethidine and midazolam) in reducing pain during minor gynecological operative procedures, including fractional curettage, dilatation and curettage and manual vacuum aspiration (MVA).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Nitrous Oxide versus Pethidine/Midazolam for Pain Relief in Minor Gynecological Operative Procedures: A Randomized Controlled Trial

2023

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Aim and Objective: To compare the analgesic effectiveness of the patient-controlled inhaled nitrous oxide (Entonox®) with intravenous opioids (pethidine/midazolam) in reducing pain during minor gynecological operative procedures, including manual vacuum aspiration (MVA), fractional curettage and dilatation and curettage. Materials and Methods: Patients undergoing minor gynecological procedures from August 2021 to December 2022 were randomized to receive nitrous oxide or intravenous pethidine (50–75 micrograms) plus midazolam (2 mg). Pain scores during and post-procedure, satisfaction level, and side effects were assessed and compared. Results: A total of 106 patients met the inclusion criteria, including 53 in the pethidine/midazolam group and 53 in the nitrous oxide group. Baseline characteristics were comparable (p-value > 0.05). Pain scores during, immediately and 30 min after procedures were not significantly different in two groups (4.94 ± 3.15, 2.74 ± 2.57, 1.58 ± 2.13 vs. 5.47 ± 2.80, 2.98 ± 2.70, 1.64 ± 2.70; p-value: 0.174, 0.634, 0.889, for pethidine/midazolam vs. nitrous oxide group, respectively. Satisfaction scores were comparable in both groups (p-value > 0.05). However, the rate of side effects was significantly lower in the nitrous oxide group (3.8% vs. 28.3%; p-value 0.001). Additionally, the discharge scores showed a significantly faster recovery time in the nitrous oxide group at 60 and 90 min after the procedure; median (IQR): 10 (9–10) vs. 9 (8–10) and 10 (10–10) vs. 10 (8.5–10); p-value 0.002 and 0.029, respectively). Conclusions: Nitrous oxide is as effective as pethidine/midazolam for pain relief in minor gynecological operative procedures but associated with significantly lower side effects and significantly faster recovery time.

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“…A needle with a larger diameter can be used to compensate the higher resistance of the cervix. For further pain control, especially in psychologically very tense patients, inhalation of nitrous oxide (N 2 O) has been proven to be safe, effective and economical [ 16 ]. The administration of i.v.…”

Section: Introductionmentioning

confidence: 99%

Opinion paper: gynecological surgery in local anesthesia?

Neis

Wallwiener

Henes

et al. 2022

Arch Gynecol Obstet

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Purpuse The paracervical block (PCB) is a local anesthesia procedure that can be used to perform gynecological surgeries without the need for further anesthesia. With the PCB, surgeries can be moved from the central operating room to outpatient operating rooms, where they can be performed without the presence of an anesthesia team. Methods In this paper, the indications, implementation and limitations of the procedure are discussed. Conclusion Especially in times of scarce staff and OR resources during the Corona pandemic, OR capacity can be expanded in this way.

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Inhalation Analgesia With Nitrous Oxide Versus Other Analgesic Techniques in Hysteroscopic Polypectomy: A Pilot Study

Cited by 21 publications

References 24 publications

A virtual reality system for pain and anxiety management during outpatient hysteroscopy—A randomized control trial

A virtual reality system for pain and anxiety management during outpatient hysteroscopy—A randomized control trial

Effectiveness of Nitrous Oxide versus Pethidine/Midazolam for Pain Relief in Minor Gynecological Operative Procedures: A Randomized Controlled Trial

Opinion paper: gynecological surgery in local anesthesia?

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