Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis

Natalie A M Cooper, Khalid S Khan, T Justin Clark, Natalie A M Cooper, Khalid S Khan, T Justin Clark

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, I(2)=0%) and paracervical (-1.28, -2.22 to -0.35, I(2)=97%) injections of local anaesthetic significantly reduced the pain in women undergoing hysteroscopy as outpatients, whereas transcervical (-0.11, -0.31 to 0.10, I(2)=27%) and topical application (-0.32, -0.97 to 0.33, I(2)= 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.

Conflict of interest statement

Competing interests: None declared.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787679/bin/coon695536.f1_default.jpg
Fig 1 Different methods of administration of local anaesthetic for outpatient hysteroscopy
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787679/bin/coon695536.f2_default.jpg
Fig 2 Study selection process for systematic review of local anaesthetic for pain relief during outpatient hysteroscopy
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787679/bin/coon695536.f3_default.jpg
Fig 3 Jadad quality assessment of studies examining use of local anaesthetic for outpatient hysteroscopy
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787679/bin/coon695536.f4_default.jpg
Fig 4 Effect of local anaesthetic on pain during outpatient hysteroscopy, according to method of administration and quality of study. Figures are mean (SMD) pain scores
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787679/bin/coon695536.f5_default.jpg
Fig 5 Incidence of vasovagal episodes in studies examining use of local anaesthetic for outpatient hysteroscopy

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