Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: A cohort study

Abstract

Study objective To evaluate and determine the main causes for pain occurrence and intensity in outpatients undergoing anesthesia-free hysteroscopy in a medical school hospital. Design Cohort study (Canadian Task Force classification II-2). Setting Diagnosis Center of the Instituto Materno-Infantil de Pernambuco. Patients One hundred seventy-one outpatients undergoing anesthesia-free diagnostic hysteroscopy. Intervention To assess pain occurrence, intensity, and associated factors reported by patients undergoing anesthesia-free diagnostic hysteroscopy. Measurements and main results Pain frequency and intensity were determined by visual analog scale (VAS) at the end of the procedure and at 15-, 30-, and 60-minute intervals. Data analysis of clinical, obstetric, and gynecologic history and its association with pain was performed. Association through χ 2 test (Pearson), risk ratio with 95% CI, and multiple logistic regression were used for statistical analysis. Pain score was higher immediately after the procedure with a median of 6, decreasing to 3, 1, and 0 at 15-, 30-, and 60-minute intervals, respectively. Multiple logistic regression was performed, and the only parameters remaining that were significantly associated with pain were menopause, speculum placement, and the absence of previous vaginal delivery. Conclusion Anesthesia-free diagnostic hysteroscopy is often associated with pain, and it has been determined that menopause, speculum placement, and absence of previous vaginal delivery are factors associated with pain occurrence and intensity.