Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial

Gülücü, Selim; Çakmak, Bülent

doi:10.5144/0256-4947.2021.135

Cited by 5 publications

(13 citation statements)

References 27 publications

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“…The included trials were performed in the following countries; one trial in Brazil, 8 one trial in Egypt, 15 one trial in Turkey, 17 one trial in India, 7 and one trial in United Kingdom. 16 Diagnostic office hysteroscopy was performed by three trials, 8,15,17 operative office hysteroscopy was done by one trial, 7 and both diagnostic and operative office hysteroscopy was done by one trial. 16 Table 1 shows the summary of the included studies, including the main findings.…”

Section: Resultsmentioning

confidence: 99%

“…Five articles were excluded and finally, five studies were included in the qualitative and quantitative synthesis. Five RCTs 7,8,15–17 met our inclusion criteria with a total number of 441 patients in which 225 were in the warmed saline group and 216 were in the room temperature saline group. The included trials were performed in the following countries; one trial in Brazil, 8 one trial in Egypt, 15 one trial in Turkey, 17 one trial in India, 7 and one trial in United Kingdom 16 .…”

Section: Resultsmentioning

confidence: 99%

“…Five RCTs 7,8,15–17 met our inclusion criteria with a total number of 441 patients in which 225 were in the warmed saline group and 216 were in the room temperature saline group. The included trials were performed in the following countries; one trial in Brazil, 8 one trial in Egypt, 15 one trial in Turkey, 17 one trial in India, 7 and one trial in United Kingdom 16 . Diagnostic office hysteroscopy was performed by three trials, 8,15,17 operative office hysteroscopy was done by one trial, 7 and both diagnostic and operative office hysteroscopy was done by one trial 16 .…”

Section: Resultsmentioning

confidence: 99%

“…They concluded that warm distension fluid can be applied in office hysteroscopy as it was linked to a significant reduction in pain score during the procedure in comparison with the unheated fluid group. 17 Kapur et al 16 evaluated in their trial the benefits of distension fluid temperature on pain and satisfaction among patients undergoing diagnostic or operative office hysteroscopy. They found no statistically significant differences between warm temperature (37 C) and room temperature (25 C) distension media regarding pain scores during and after hysteroscopy, patient satisfaction, image clarity, and ease of the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Gulucu and Cakmak 17 published a recent RCT in which they included 100 perimenopausal women with abnormal uterine bleeding undergoing diagnostic office hysteroscopy to compare normal saline distension medium either at room temperature (25°C) or at warm body temperature (37°C) in terms of pain scores. They concluded that warm distension fluid can be applied in office hysteroscopy as it was linked to a significant reduction in pain score during the procedure in comparison with the unheated fluid group 17 . Kapur et al 16 evaluated in their trial the benefits of distension fluid temperature on pain and satisfaction among patients undergoing diagnostic or operative office hysteroscopy.…”

Section: Discussionmentioning

confidence: 99%

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Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta‐analysis of randomized controlled trials

Baradwan

Khalil

Alshahrani

et al. 2022

J of Obstet and Gynaecol

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Aim To evaluate the impact of warm distension medium versus room temperature distension medium on pain control among patients undergoing office hysteroscopy. Methods A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to October 2021. We selected randomized clinical trials (RCTs) compared warmed saline distension medium in the intervention group versus room temperature distension medium in the control group among women undergoing diagnostic and/or operative office hysteroscopy. Revman software was utilized for performing our meta‐analysis. Our primary outcomes were pain scores evaluated by the visual analog scale (VAS) during and after the procedure. Our secondary outcome was the patient satisfaction between both groups. Results Five RCTs met our inclusion criteria with a total number of 441 patients. We found warm saline was linked to a significant reduction in the VAS pain score during the procedure compared to the control group (mean difference [MD] = −1.12, 95% confidence interval [CI] [−1.80, −0.45], p = 0.001). Moreover, the VAS pain score after the procedure was significantly declined among the warm saline group (MD = −0.62, 95% CI [−0.97, −0.27], p = 0.005). Interestingly, more patients were significantly satisfied with warm saline distension medium application compared to room temperature group (odds ratio [OR] = 3.71, 95% CI [2.01, 6.86], p < 0.001). Conclusions Warm saline application in office hysteroscopy is effective in reducing pain during and after the procedure as well as improvement in patient satisfaction.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta‐analysis of randomized controlled trials

Baradwan

Khalil

Alshahrani

et al. 2022

J of Obstet and Gynaecol

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Outpatient Hysteroscopy

De Silva,

Smith,

Cooper

et al. 2024

BJOG

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Key recommendations All gynaecology departments should provide a dedicated outpatient hysteroscopy service to aid care of women and people with abnormal uterine bleeding, reproductive problems, and insertion/retrieval of intrauterine devices. [Grade A] Written information should be provided to the woman prior to their appointment. This should include details about the procedure, the benefits and risks, advice regarding pre‐operative analgesia, as well as alternative options for care and contact details for the hysteroscopy unit. [Good Practice Point] Women should be made aware of other settings and modes of anaesthesia for hysteroscopy (e.g. under general or regional anaesthesia or intravenous sedation). [GPP] The woman should be advised that if they find the procedure too painful or distressing at any point, they must alert the clinical team who will stop the procedure immediately. The clinical team should alert the hysteroscopist if the woman appears to be in too much pain or is experiencing a vasovagal episode and therefore unable to voice the concerns so that the procedure can be stopped. [GPP] Women should be advised to take standard doses of oral non‐steroidal anti‐inflammatory agents (NSAIDs) one hour before their scheduled appointment. Vaginoscopy should be the standard technique for outpatient hysteroscopy unless the use of a vaginal speculum is required (e.g. for administering local cervical anaesthesia or dilating the cervix). [Grade A] When performing operative hysteroscopy, the smallest diameter hysteroscope should be used, with consideration given to the use of hysteroscopes with expandable outer working channels because they are associated with less pain. [Grade B] Mechanical hysteroscopic tissue removal systems should be preferred over miniature bipolar electrodes to remove endometrial polyps. [Grade A] Local anaesthesia should not be routinely administered prior to outpatient hysteroscopy where a vaginoscopic approach is used. It should be considered where use of a vaginal speculum is planned e.g. for cervical dilatation if anticipated, due to either cervical stenosis and/or the utilisation of larger‐diameter hysteroscopes (≥5mm outer diameter). [Grade A] Saline should be instilled at the lowest possible pressure to achieve a satisfactory view. [Grade A] Conscious sedation should not be routinely used in outpatient hysteroscopic procedures. [Grade B]

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The effect of informing the patient about the procedure with video imaging before office hysteroscopy on pain

Çallıoğlu,

Kanza Gül,

Özer Aslan

et al. 2023

J of Obstet and Gynaecol

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ObjectiveTo evaluate the effect of informing patients undergoing diagnostic office hysteroscopy via a video 24 h before the procedure and determine the changes in pain scores, channel transit time, the degree of difficulty of the procedure, and physiological parameters.DesignSingle‐blind randomized controlled trial.SettingThe study was conducted between September 1, 2021 and April 1, 2022 at the University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital.ParticipantsA total of 134 patients aged 18–65 years who needed diagnostic office hysteroscopy.InterventionsParticipants were randomized into two groups, the standard information group (Group 1: controls), and the video information + standard information group (Group 2). After office hysteroscopy, a visual analog scale (VAS) and Likert scale were used to assess pain and the degree of difficulty of the procedure, respectively. Physiological parameters were evaluated before and after the procedure.Main Outcome MeasureTo determine the effect of video‐based multimedia information administered 24 h before office hysteroscopy on post‐procedure pain.ResultsThe mean VAS score of the group that watched the training video (3.02 ± 1.88) was significantly lower than the control group (4.72 ± 2.54) who did not watch the training video (p < 0.001). The mean cervical channel transit time in seconds (sec) during the procedure was found to be significantly higher in the control group (21.57 ± 15.10 s) than in the video‐watching group (p = 0.011). There was no significant difference between the groups in terms of physiological parameters and the degree of ease of the procedure.ConclusionOur study has shown that informing patients in a pre‐procedure video is an effective approach that shortens the duration of the channel transit time and reduces pain.

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Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial

Cited by 5 publications

References 27 publications

Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta‐analysis of randomized controlled trials

Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta‐analysis of randomized controlled trials

Outpatient Hysteroscopy

The effect of informing the patient about the procedure with video imaging before office hysteroscopy on pain

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