Effectiveness of Warm Saline Distension Media on Relieving Pain in Outpatient Office Hysteroscopy: A Randomized Controlled Clinical Trial

Abstract

Background: Outpatient hysteroscopy is the preferred examination procedure for diagnosis of intrauterine pathology and abnormal uterine bleeding causes, in addition for therapeutic operative management. It is desirable to apply as many procedures as possible with an office hysteroscopy, if they are implemented in a safe and effective fashion. Aim: Evaluation and investigation of the effectiveness of warm saline distensibility media in reducing the pain perceived in women undergoing diagnostic hysteroscopy procedure. Methodology: A randomized controlled clinical research trial that recruited 82 women scheduled for outpatient office hysteroscopy in Early cancer detection unit in Ain Shams Maternity Hospital from April 2017 till May 2018. Two research groups were categorized into warm saline and normal room temperature saline research groups each contained 41 cases. Comparative analysis of pain perceived in both groups was conducted to assess efficiency of warm saline to reduce pain perception. Results: Hysteroscopic findings didn’t differ significantly between the two groups, namely ease of introduction of hysteroscope, position of uterus and morphological appearance of the ectocervix, endocervical canal, endometrium, endometrial cavity, and tubal ostia. Also, no statistically significant differences were observed between the two groups in the duration of procedure. Parameters of pain assessment differed statistically significantly between the two research groups. p value <0.001 .Simple analysis of VAS scores revealed a statistically significantly lower VAS score at the end of the procedure in the warm distention medium group in comparison to the room-temperature distention medium group. The same finding remained constant after 15 minutes from the end of the procedure. Assessment of variation of VAS score with combined variation of temperature of distention medium over time was assessed using repeated measure ANOVA analysis. Patient satisfaction, indicated by the proportion of the patients who would undergo the hysteroscopic examination again by usage of same method, was statistically significantly higher in the warm distention medium research group in comparison to the room-temperature medium research group (89.74% vs 71.05% consecutively).(p value <0.04) Conclusions: Pain is measured by VAS score is statistical significantly lower at the end of the procedure in warm saline distension medium research group in comparison to room temperature distension medium research group (1.64+0.82vs 3.05+1.17) consecutively. Denoting possible effectiveness of warm saline in reducing pain perceived in office hysteroscopy