Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis
Abstract
Objective To compare the effects of different types of local anaesthetic for pain control during outpatient hysteroscopy.
Design Systematic review and meta-analysis of randomised controlled trials.
Setting Outpatient hysteroscopy clinics.
Participants Women undergoing diagnostic or operative hysteroscopy as outpatients—that is, without general anaesthesia.
Study selection criteria
Medline, Embase, CINAHL, the Cochrane library, and reference lists of
relevant studies. Two reviewers independently selected trials. Data were
abstracted on quality, characteristics, and results.
Results
There were 20 trials (2851 participants). Data from 15 of these were
meta-analysed in subgroups defined by type of intervention and study
quality. Intracervical (standardised mean difference −0.36, 95%
confidence interval −0.61 to −0.10, I2=0%) and paracervical (−1.28, −2.22 to −0.35, I2=97%)
injections of local anaesthetic significantly reduced the pain in women
undergoing hysteroscopy as outpatients, whereas transcervical (−0.11,
−0.31 to 0.10, I2=27%) and topical application (−0.32, −0.97 to 0.33, I2=
90%) did not. Meta-regression showed that paracervical injection was
superior to the other anaesthetic methods (P=0.04), a finding that was
supported by the high quality subgroup of studies. Use of local
anaesthetic did not have a significant effect on the incidence of
vasovagal episodes (P=0.09).
Conclusions Paracervical local anaesthetic injection is the best method of pain control for women undergoing hysteroscopy as outpatients.
Edited from bmj.com
Picture from konskerobgyn.com
#anaesthesia #hysteroscopy
