Lidocaine 10% sprays versus oral diclofenac sodium for pain relief in women undergoing hysterosalpingography for infertility workup: A randomized clinical trial

Abstract

ABSTRACT Background Tubal disease is the leading cause of female infertility in the West African sub-region and hysterosalpingography (HSG) is the first-line imaging technique in its assessment. HSG is an acutely painful procedure. Various studies on analgesia for HSG were inconclusive. We compared the efficacy of 10 mg lidocaine 10% spray and 50 mg oral diclofenac sodium for pain relief during HSG. Methods This randomized clinical trial was carried out at the Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria between December 2019 and December 2021, among one hundred and eight eligible women undergoing HSG as part of their infertility workup. Ethical clearance was obtained from the ethics committee of the hospital with Protocol number ERC/2019/01/14. They were randomized into two groups. One group of 54 patients received 10 mg of 10% lidocaine spray and an oral placebo, while the second group of 54 women had 50 mg of oral diclofenac sodium and normal saline spray. Pain scores were assessed using a 10 cm visual analog scale at cervical traction, instillation of contrast media, and thirty minutes after HSG. The mean pain scores, the need for additional analgesia, and the occurrence of adverse drug reactions were compared between the two groups. Result Those in the oral diclofenac group had significantly lower pain scores than the 10% Lidocaine group 30 minutes after HSG; 1.13 ± 1.06 Vs. 2.04 ± 1.26 (p < 0.001). The additional analgesic requirement also showed no statistically significant difference between the two groups. Conclusion This study showed that oral diclofenac sodium is comparable to lidocaine spray for pain relief during HSG. It also has the additional benefit of improved quality of life 30 mins after HSG as evidenced by effective pain relief. Consideration should be given to the use of oral diclofenac sodium for pain relief during and after HSG in well-selected patients.