Pain relief for women undergoing oocyte retrieval for assisted reproduction

Kwan, Irene; Wang, Rui; Pearce, Emily; Bhattacharya, Siladitya

doi:10.1002/14651858.cd004829.pub4

Cited by 45 publications

(22 citation statements)

References 52 publications

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“…The intensity of pain reported by our cohort of women is substantially higher than that reported in a recent systematic review [5]. Explanations for this finding may be related to several factors, including the fact that women in our study did not receive regional anesthesia or local anesthetics, were not allowed to take NSAIDs before or after the procedure, and…”

Section: Discussioncontrasting

confidence: 58%

“…Discomfort and pain after ART has been attributed to the mechanical process of ovarian enlargement similar to midcycle pelvic pain (Mittleschmerz) [4], the operative procedure itself, and the resulting post-operative accumulation of peritoneal fluid and blood [5]. The ovulation induction protocols utilized in ART are designed to induce supraphysiologic oocyte recruitment.…”

Section: Introductionmentioning

confidence: 99%

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Hormonal and Clinical Predictors for Post–egg Retrieval Pain in Women Undergoing Assisted Reproductive Technology Procedures

Vuilleumier

Dinges

Ciliberto

et al. 2016

The Clinical Journal of Pain

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ObjectivesThe intensity of post-egg retrieval pain is underestimated, with few studies examining postprocedural pain and predictors to identify women at risk for severe pain. We evaluated the influence of pre-procedural hormonal levels, ovarian factors, as well as mechanical temporal summation (mTS) as predictors for post-egg retrieval pain in women undergoing in vitro fertilization (IVF). MethodsEighteen women scheduled for ultrasound-guided egg retrieval under standardized anesthesia and post-procedural analgesia were enrolled. Pre-procedural mTS, questionnaires, clinical data related to anesthesia and the procedure itself, post-procedural pain scores and pain medication for breakthrough pain were recorded. Statistical analysis included Pearson product moment correlations, Mann-Whitney U tests and multiple linear regressions. ResultsAverage peak post-egg retrieval pain during the first 24 hours was 5.0 ± 1.6 on an NRS scale (0=no pain, 10=worst pain imaginable). Peak post-egg retrieval pain was correlated with basal antimullerian hormone (AMH) (r=0.549, p=0.018), pre-procedural peak estradiol (r=0.582, p=0.011), total number of follicles (r=0.517, p=0.028) and number of retrieved eggs (r=0.510, p=0.031). Ovarian hyperstimulation syndrome (OHSS) (n=4) was associated with higher basal AMH (p=0.004), higher peak pain scores (p=0.049), but not with peak estradiol (p=0.13). The mTS did not correlate with peak post-procedural pain (r=0.266, p=0.286), or peak estradiol level (r=0.090, p=0.899).Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited. DiscussionPeak post-egg retrieval pain intensity was higher than anticipated. Our results suggest that post-egg retrieval pain can be predicted by baseline AMH, high peak estradiol, and OHSS.Further studies to evaluate intra-and post-procedural pain in this population are needed, as well as clinical trials to assess post-procedural analgesia in women presenting with high hormonal levels.

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Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Hormonal and Clinical Predictors for Post–egg Retrieval Pain in Women Undergoing Assisted Reproductive Technology Procedures

Vuilleumier

Dinges

Ciliberto

et al. 2016

The Clinical Journal of Pain

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“…For ambulatory procedures, conscious sedation is preferable for the patients as their recovery times are shorter in comparison with general anaesthesia (Piroli et al., 2012). Therefore, OPU under conscious sedation is usually a suitable option for patients and operators alike (Kwan et al., 2018).…”

Section: Recommendationsmentioning

confidence: 99%

“…Overall, evidence does not support one particular method or technique over another (Kwan et al., 2018). Different options should be discussed with the patients; patient preference (including cultural preferences) should be considered, as well as patient selection.…”

Section: Recommendationsmentioning

confidence: 99%

Recommendations for good practice in ultrasound: oocyte pick up†

D’Angelo

Panayotidis

Amso

et al. 2019

Human Reproduction Open

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STUDY QUESTION What is good practice in ultrasound (US), and more specifically during the different stages of transvaginal oocyte retrieval, based on evidence in the literature and expert opinion on US practice in ART? SUMMARY ANSWER This document provides good practice recommendations covering technical aspects of US-guided transvaginal oocyte retrieval (oocyte pick up: OPU) formulated by a group of experts after considering the published data, and including the preparatory stage of OPU, the actual procedure and post-procedure care. WHAT IS KNOWN ALREADY US-guided transvaginal OPU is a widely performed procedure, but standards for best practice are not available. STUDY DESIGN, SIZE, DURATION A working group (WG) collaborated on writing recommendations on the practical aspects of transvaginal OPU. A literature search for evidence of the key aspects of the procedure was carried out. Selected papers (n = 190) relevant to the topic were analyzed by the WG. PARTICIPANTS/MATERIALS, SETTING, METHODS The WG members considered the following key points in the papers: whether US practice standards were explained; to what extent the OPU technique was described and whether complications or incidents and how to prevent such events were reported. In the end, only 108 papers could be used to support the recommendations in this document, which focused on transvaginal OPU. Laparoscopic OPU, transabdominal OPU and OPU for IVM were outside the scope of the study. MAIN RESULTS AND THE ROLE OF CHANCE There was a scarcity of studies on the actual procedural OPU technique. The document presents general recommendations for transvaginal OPU, and specific recommendations for its different stages, including prior to, during and after the procedure. Most evidence focussed on comparing different equipment (needles) and on complications and risks, including the risk of infection. For these topics, the recommendations were largely based on the results of the studies. Recommendations are provided on equipment and materials, possible risks and complications, audit and training. One of the major research gaps was training and competence. This paper has also outlined a list of research priorities (including clarification on the value or full blood count, antibiotic prophylaxis and flushing, and the need for training and proficiency). LIMITATIONS, REASONS FOR CAUTION The recommendations of this paper were mostly based on clinical expertise, as at present, only a few clinical trials have focused on the oocyte retrieval techniques, and almost all available data are observational. In addition, studies focusing on OPU were heterogeneous with significant difference in techniques used, which made drafting conclusions and recommendations based on these studies even more challenging. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on the management of good laboratory practice in ART. Some useful troubleshooting/checklist recommendations are given for easy implementation in clinical practice. These recommendations aim to contribute to the standardization of a rather common procedure that is still performed with great heterogeneity. STUDY FUNDING/COMPETING INTEREST(S) The meetings of the WG were funded by ESHRE. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER NA. ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.

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“…In addition, the combination of intravenous sedatives and acupuncture procedures can produce satisfactory postoperative analgesia, which may help to reduce the risk of opioid overuse. In a Cochrane review, Kwan et al [106] included 24 randomized controlled trials (RCTs; from 3160 participants) to evaluate several combinations of sedation and analgesia for pain relief and pregnancy outcomes in women who underwent oocyte retrieval. This study found that the simultaneous use of sedation, opioid analgesia, and nerve block or acupuncture techniques resulted in better pain relief compared to any single intervention.…”

Section: Prevention Strategies For Opioid Abusementioning

confidence: 99%

Risk Factors and Prevention Strategies for Postoperative Opioid Abuse

Zhao

Chen

Feng

et al. 2019

Pain Research and Management

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Worldwide, 80% of patients who undergo surgery receive opioid analgesics as the fundamental agent for pain relief. However, the irrational use of opioids leads to excessive drug dependence and drug abuse, resulting in an increased mortality rate and huge economic loss. The crisis of opioid overuse remains a great challenge. In this review, we summarize several key factors in opioid abuse, including race, region, income, genetic factors, age and gender, smoking and alcohol abuse, history of chronic pain and analgesic drug abuse, surgery, neuropsychiatric illness, depression and antidepressant use, human factors, national policies, hospital regulations, and health insurance under treatment of pain. Furthermore, we present several prevention strategies, such as perioperative measures, opioid substitutes, treatment of the primary illness, emotional regulation, use of opioid antagonists, efforts of the state, hospitals, doctors and pharmacy benefit managers, gene therapy, and vaccines. Greater understanding and better assessment are required of the risks associated with opioid abuse to ensure the safety and analgesic effects of pain treatment after surgery.

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Pain relief for women undergoing oocyte retrieval for assisted reproduction

Abstract: Pain relief for women undergoing oocyte retrieval for assisted reproduction.

Cited by 45 publications

References 52 publications

Hormonal and Clinical Predictors for Post–egg Retrieval Pain in Women Undergoing Assisted Reproductive Technology Procedures

Hormonal and Clinical Predictors for Post–egg Retrieval Pain in Women Undergoing Assisted Reproductive Technology Procedures

Recommendations for good practice in ultrasound: oocyte pick up†

Risk Factors and Prevention Strategies for Postoperative Opioid Abuse

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