Evaluation of four different methods of analgesia for pain relief in patients of dilatation & curettage: A randomized comparative study

Abstract

Introduction: Dilatation and curettage is a diagnostic procedure in management of abnormal uterine bleeding. In a developing country like India with dense population and limited resources it becomes a necessity to provide simple, effective, inexpensive and low-risk method of pain relief which can be used in an outpatient setup. So, this study was planned to determine an effective modality of pain relief for this procedure. Methods: This was a prospective, randomized, comparative study conducted among 140 patients. The patients were divided into 4 groups: Group A: Paracervical block Group B: Paracervical block with intrauterine lignocaine Group C: Intravenous diclofenac Group D: Intravenous diclofenac with intrauterine lignocaine Pain was analyzed using pain rating scale immediately and 30 min after the procedure. Patient was assessed 2 hourly after the procedure using PADSS score (post anaesthetic discharge scoring system scale) and patient was discharged if PADSS score is more than 9. Results: The patients were well matched in age, parity, weight, number of vaginal births, menopausal status and indications for intervention among the groups and no statistically significant differences were observed in the baseline characteristics. Patients in Group B (Paracervical block with intrauterine lignocaine) had significantly low pain score immediately (1.69±0.47)as well as 30 min after the procedure(2.37±0.49), followed by group D (intravenous diclofenac with intrauterine lignocaine 3.71±0.75, 4.51±0.65). Group A and Group C required rescue analgesic in 25 and 22 patients respectively. However, rescue analgesic was required in only 3 patients of group D Early discharge of the patient was observed in group using combination of paracervical block with intrauterine lignocaine which had maximum PADDS score (11.71±0.45 at 2 hours after the procedure). No serious adverse effects were observed during the study. Most common adverse effect observed was nausea and vomiting apart from other minor adverse effect like dizziness, light-headiness, nausea/vomiting, metallic taste and perioral numbness. Conclusion: Adequate intraoperative and postoperative analgesia is ensured when combination of analgesic/ anaesthetic agent is used. Maximum pain relief, as reflected by pain scores was in group using combination of paracervical block and intrauterine lignocaine which also had highest PADDS score that allowed early discharge of the patient.