Inhalation analgesia with nitrous oxide versus other analgesic techniques in hysteroscopic polypectomy: a pilot study

Area of Science:

• Gynecology
• Pain Management
• Anesthesiology

Background:

• Hysteroscopic polypectomy is a common gynecological procedure.
• Pain and discomfort can be significant during hysteroscopic polypectomy.
• Effective pain management is crucial for patient tolerance and procedural success.

Purpose of the Study:

• To evaluate the efficacy of inhaled nitrous oxide (50% equimolar mixture of nitrogen protoxide and oxygen) for pain relief during hysteroscopic polypectomy.
• To compare the effectiveness of nitrous oxide with paracervical anesthesia and a control group.
• To assess patient tolerance and procedural complications associated with different analgesic methods.

Main Methods:

• A sequential study involving 106 patients undergoing office hysteroscopy and polypectomy.
• Patients were divided into three groups: control (no treatment), inhaled nitrous oxide, and paracervical infiltration with 1% lidocaine.
• Pain was measured using the visual analog scale, and tolerance was assessed qualitatively by medical staff.

Main Results:

• Patients receiving nitrous oxide reported significantly lower pain scores compared to the control and paracervical infiltration groups (mean 3.55 vs. 5.49 and 4.22, respectively).
• Medical staff reported very good tolerance for the nitrous oxide group, compared to good for paracervical infiltration and bad for the control group.
• Complications occurred in over 50% of patients in the paracervical infiltration group, whereas 82% of patients in the nitrous oxide group experienced no complications.

Conclusions:

• Inhaled nitrous oxide is a safe and effective analgesic technique for hysteroscopic polypectomy.
• Nitrous oxide offers superior pain relief and patient tolerance compared to paracervical infiltration and no treatment.
• This method presents a viable alternative for managing pain during outpatient gynecological procedures.