Comparison between the analgesic effect of lidocaine dissolved in distension medium and rectal diclofenac sodium during outpatient hysteroscopy

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Tarek Elhussieny Mohamed, Omar Ibrahim Abd El tawab, Basma Makin Abd El Azeem, Shimaa Mostafa Abd El Fatah, Manal Abd Rabou Moussa

Abstract

Background: A clinical technique known as an outpatient hysteroscopy is utilised for a variety of therapeutic and diagnostic purposes. However, discomfort is the most common side effect and reason for procedure failure. Objectives: The aims of this study were: To assess the analgesic efficacy of lidocaine dissolved in the distension medium compared to rectal diclofenac sodium during anesthesia free diagnostic hysteroscopy, and To minimize diagnostic hysteroscopy cancellation due to associated pain. Study Design: This was a comparative randomized observational study conducted at Kasr Alainy Hospital in the outpatient hysteroscopy clinic from November 2018 to November 2019. One hundred nulliparous women who underwent diagnostic office hysteroscopy were divided randomly into 100mg rectal diclofenac group and 10ml of lidocaine 2% dissolved in 500ml saline group The perception of pain was assessed during hysteroscope insertion, visualization of uterine cavity and 30minutes after the procedure using the Visual analogue scale (VAS). The patient was considered in pain with VAS ≥ 4. Results: Intrauterine instillation of 10 ml lidocaine 2% was inferior to100mg rectal diclofenac in reducing the pain during office hysteroscopy insertion, uterine visualization and 30 minutes after the procedure proved statistically by significant difference (P value < 0.001). Both drugs were tolerable with no observed adverse events. Conclusion: Rectal diclofenac was more effective than intrauterine lidocaine in pain relief during outpatient hysteroscopy.

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