Abstract
Background Pain, anxiety, and distress are common in radiological investigations including hysterosalpingogram (HSG). Studies suggest that sedation allows patients to better tolerate diagnostic imaging and image-guided procedures by relieving anxiety, discomfort, and pain. This study aimed at assessing the safety and effectiveness of ketamine use in HSG and the proportion of true positive bilateral tubal blockage during HSG using the Jimah Procedure. Methods We performed repeated HSG workup under IV ketamine (20–40 mg/mL) sedation for 27 infertile women at the Cape Coast Teaching Hospital. The exclusion criteria included unilateral tubular blockage, acute infection of the vagina or cervix, active vaginal bleeding, glaucoma, and high blood pressure at the time of the study. Data were entered with Microsoft Excel and analyzed using SPSS version 21. Results A total of 27 patients (age range: 25–48 years) previously diagnosed of bilateral tubal blockage or spasm were enrolled for the repeat HSG procedure. The median age was 34 years (IQR: 32–37), while secondary infertility (20) (74.1%) was the commonest indication. None of the patients reported of pain or distress during or after the procedure. Two (7.4%) women vomited after HSG. Twelve patients (44.4%) had bilateral tubal blockage (true positive), while tubal patency was seen in 15 (55.6%) patients on HSG under ketamine sedation. Conclusion This study found IV ketamine sedation produces profound anesthesia and analgesia and eliminates tubal spasm. We recommend that radiologists in developing countries should consider sedating patients during HSG and documenting observations and patients' feedback to help assess safety and effectiveness in local settings.
Highlights
Pain, anxiety, and psychological and physical distress are likened to radiological investigations including hysterosalpingogram (HSG) [1,2,3]. ese complications can be ameliorated by the use of sedation and analgesia [1]
Little information exists on the use of sedation in HSG procedure in Sub-Saharan Africa and Ghana. is finding suggests that radiologists are not sedating their patients during HSG or failing to document local experience to inform practice
Study Design. is is a cross-sectional study involving 27 women, undergoing repeated HSG under ketamine sedation for bilateral tubal blockage over 2 years (January 2018 to December 2020) at the Department of Imaging, Cape Coast Teaching Hospital, Ghana. is represents 13.3% of the 203 women who presented for the HSG procedure and were initially diagnosed with bilateral tubal blockage. e initial study [4] involving 203 women underwent the traditional method of performing HSG in Ghana, which does not include ketamine sedation. e 27 patients, had the new procedure called the “Jimah procedure” which is a modified version of the traditional procedure and involves IV ketamine use
Summary
Anxiety, and psychological and physical distress are likened to radiological investigations including hysterosalpingogram (HSG) [1,2,3]. ese complications can be ameliorated by the use of sedation and analgesia [1]. Anxiety, and psychological and physical distress are likened to radiological investigations including hysterosalpingogram (HSG) [1,2,3]. HSG is noninvasive, patients’ anxiety and psychological and physical distress might interfere with the procedure and subsequent outcome [1, 2]. Studies suggest that sedation allows patients to better tolerate diagnostic imaging and image-. Anxiety, and distress are common in radiological investigations including hysterosalpingogram (HSG). Studies suggest that sedation allows patients to better tolerate diagnostic imaging and image-guided procedures by relieving anxiety, discomfort, and pain. Is study aimed at assessing the safety and effectiveness of ketamine use in HSG and the proportion of true positive bilateral tubal blockage during HSG using the Jimah Procedure. A total of 27 patients (age range: 25–48 years) previously diagnosed of bilateral tubal blockage or spasm were enrolled for the repeat HSG procedure
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