Pain in diagnostic hysteroscopy: a multivariate analysis after a randomized, controlled trial
Ivan Mazzon1, Alessandro Favilli2, Mario Grasso1
1"Arbor Vitae" Center, Clinica Nuova Villa Claudia, Rome, Italy.
Objective:
To study which variables are able to influence women's experience of pain during diagnostic hysteroscopy.
Design:
Multivariate analysis (phase II) after a randomized, controlled trial (phase I).
Setting:
Endoscopic gynecologic center.
Patient(S):
In phase I, 392 patients were analyzed. Group A: 197 women with carbon dioxide (CO2); group B: 195 women with normal saline. In phase II, 392 patients were assigned to two different groups according to their pain experience as measured by a visual analogue scale (VAS): group VAS>3 (170 patients); group VAS≤3 (222 patients).
Intervention(S):
Free-anesthesia diagnostic hysteroscopy performed using CO2 or normal saline as distension media.
Main Outcome Measure(S):
Procedure time, VAS score, image quality, and side effects during and after diagnostic hysteroscopy.
Result(S):
In phase I the median pain score in group A was 2, whereas in group B it was 3. In phase II the duration of the procedure, nulliparity, and the use of normal saline were significantly correlated with VAS>3. A higher presence of cervical synechiae was observed in the group VAS>3. The multivariate analysis revealed an inverse correlation between parity and a VAS>3, whereas the use of normal saline, the presence of synechiae in the cervical canal, and the duration of the hysteroscopy were all directly correlated to a VAS score>3.
Conclusion(S):
Pain in hysteroscopy is significantly related to the presence of cervical synechiae, to the duration of the procedure, and to the use of normal saline; conversely, parity seems to have a protective role.
Clinical Trial Registration Number:
NCT01873391.
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