A Systematic Review of the Effect of Type, Pressure, and Temperature of the Distension Medium on Pain During Office Hysteroscopy.
De Silva, Prathiba M Stevenson, Helen Smith, Paul P Justin Clark, T
De Silva, Prathiba M
Stevenson, Helen
Smith, Paul P
Justin Clark, T
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University of Birmingham; Birmingham Women's and Children's NHS Foundation Trust; Sandwell and West Birmingham NHS Trust
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Publication date
2021-01-11
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Abstract
Objective: To identify the optimal distension medium type, pressure, and temperature to minimize pain during office hysteroscopy.
Data sources: MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to January 29, 2020.
Methods of study selection: We included randomized controlled trials in which women undergoing office hysteroscopy were randomized to either a distension medium type, pressure, or temperature against a suitable control, where pain was an outcome. Data regarding feasibility, visualization, complications, and satisfaction were also collected.
Tabulation, integration, and results: The literature search returned 847 studies, of which 18 were included for systematic review and 17 for meta-analysis. There was no significant difference in intraprocedural pain when comparing the use of normal saline against carbon dioxide (standardized mean difference [SMD], -0.12; 95% confidence interval [CI], -0.36 to 0.13). Subgroup analysis of high-quality studies revealed a statistically significant reduction in postprocedural pain with normal saline (SMD, -0.65; 95% CI, -1.14 to -0.16). Side effects were less frequent (Peto odds ratio, 0.29; 95% CI, 0.20-0.40) and patient satisfaction was higher (SMD, 1.39; 95% CI, 0.51-2.28) with normal saline compared with carbon dioxide. Pressures of ≤40 mm Hg reduced intraprocedural pain (SMD, -0.67; 95% CI, -1.09 to -0.26) at the expense of a higher proportion of unsatisfactory views (81%-89% at ≤40 mm Hg vs 95%-99% at ≥50 mm Hg). Postprocedural pain was reduced with lower filling pressures. Warming saline did not reduce intraprocedural pain (SMD, 0.59; 95% CI, -0.14 to 1.33).
Conclusion: Normal saline, instilled at the lowest pressure to acquire a satisfactory view, should be used for uterine distension during office hysteroscopy to minimize pain.
Citation
De Silva, P. M., Stevenson, H., Smith, P. P., & Justin Clark, T. (2021). A Systematic Review of the Effect of Type, Pressure, and Temperature of the Distension Medium on Pain During Office Hysteroscopy. Journal of minimally invasive gynecology, 28(6), 1148–1159.e2.
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Article