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Nitrous oxide versus lidocaine versus no analgesic for in-office hysteroscopy: a randomised clinical trial

J A Solano Calvo1, C Del Valle Rubido2, A Rodríguez-Miguel3,4

  • 1Department of Obstetrics and Gynaecology, University Hospital 'Príncipe de Asturias', Alcalá de Henares, Madrid, Spain.

BJOG : an International Journal of Obstetrics and Gynaecology
|February 2, 2021
PubMed

Insights

Inhaled nitrous oxide (INO) effectively manages pain during hysteroscopy, matching lidocaine

Area of Science:

  • Gynecology
  • Pain Management
  • Anesthesiology

Background:

  • In-office hysteroscopy is a common gynecological procedure.
  • Effective pain management is crucial for patient comfort and procedure success.
  • Current analgesic options for hysteroscopy have varying efficacy and tolerability.

Purpose of the Study:

  • To compare the efficacy of inhaled nitrous oxide (INO) versus 1% lidocaine paracervical infiltration and no analgesic for pain control during in-office hysteroscopy.
  • To evaluate the tolerability and adverse events associated with each pain management strategy.

Main Methods:

  • A single-blind, stratified randomized clinical trial was conducted with 314 women undergoing hysteroscopy.
  • Participants were randomized into three groups: inhaled nitrous oxide (INO), 1% lidocaine paracervical block, or no analgesic.
  • Pain was assessed using a Visual Analogue Scale (VAS) by a blinded gynecologist.

Main Results:

  • Inhaled nitrous oxide (INO) and 1% lidocaine showed comparable pain reduction (mean VAS 34.7 mm and 36.1 mm, respectively).
  • The no-analgesic group reported significantly higher pain scores (mean VAS 47.3 mm).
  • INO demonstrated better tolerability with fewer reported adverse events compared to 1% lidocaine.

Conclusions:

  • Inhaled nitrous oxide (INO) is an effective and well-tolerated option for pain management during in-office hysteroscopy.
  • INO offers comparable analgesia to 1% lidocaine paracervical infiltration.
  • Avoiding analgesia is the least recommended approach for pain control during hysteroscopy.
Abstract

Keywords:
Analgesiahysteroscopynitrous oxide

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