Vaginal Misoprostol versus a Rectal Nonsteroidal Anti-Inflammatory Drug to Reduce Pain during Pipelle Endometrial Biopsies: A Prospective, Randomized, Placebo-Controlled Trial

Abstract

Background: To evaluate and compare the efficacy of vaginal misoprostol and a rectal nonsteroidal anti-inflammatory drug (NSAID) on pain relief during Pipelle endometrial biopsies in a placebo-controlled randomized study. Methods: One hundred and fifty-one women who had an indication for a Pipelle endometrial biopsy were randomized into three groups as follows: group 1, vaginal misoprostol; group 2, rectal NSAID, and group 3, control. After the procedure, the women were asked to record their pain severity on a visual analog scale. The secondary outcome of the study was patient acceptability, and vasovagal symptoms and analgesic requirements after the procedure were also recorded. Results: There were no statistically significant differences in the demographic characteristics of the patients. The primary study outcome was the comparison of the median visual analog scale pain scores of groups 1 and 2 versus group 3 (controls); no statistically significant differences were found (p = 0.502). In addition, the patient acceptability (Likert scale), vasovagal symptoms and analgesic requirements after the procedure were similar among the groups (p = 0.204, 1 and 0.546, respectively). Conclusion: Our study did not demonstrate a reduction in pain relief during Pipelle endometrial biopsies for patients receiving vaginal misoprostol or a rectal NSAID when compared to patients receiving placebo treatment.

The Effectiveness and Acceptability of Pipelle Endometrial Sampling versus Classical Dilatation and Curettage: A Three-Year Observational Study

“…Although several studies concluded that Pipelle significantly produced less pain than D&C [10,11,12], other studies reported the occurrence of mild-to-severe pain during Pippelle endometrial sampling [13,14,15]. …”

“…The secondary outcome of the study was patient acceptability, vasovagal symptoms and analgesic requirements. The study did not demonstrate a reduction in pain during Pipelle endometrial biopsies for patients receiving either vaginal misoprostol or rectal indomethacin when compared to patients receiving placebo treatment [14]. …”

Use of Oral Misoprostol for Cervical Priming before Hysteroscopy: A Randomized Comparison of Two Dosages

“…Four hundred micrograms of oral or vaginal misoprostol is found useful for cervical dilatation up to 10 mm prior to operative hysteroscopy [15]. Other studies have denied any benefits from oral use of 400 µg of misoprostol before hysteroscopy or even before pipelle sampling of the endometrium [16,17]. The majority of these studies compared misoprostol to placebo.…”

Pain Management for Gynecologic Procedures in the Office

“…Regardless of route of administration, no benefit was demonstrated, and there is possible harm given that misoprostol itself causes cramping. 31,32 Several trials demonstrated a modest benefit on pain with an intrauterine lidocaine infusion when compared with saline. 33,34 This is most commonly administered transcervically with a 91 Pain Management for Gynecologic Procedures • CME Review Article syringe attached to an angiocatheter, which is left in place between 3 and 5 minutes prior to endometrial biopsy to prevent backflow out of the cervical os.…”