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Meta-Analysis
. 2010 Mar 23:340:c1130.
doi: 10.1136/bmj.c1130.

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

Natalie A M Cooper  1 , Khalid S Khan, T Justin Clark
Affiliations
Meta-Analysis

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

Natalie A M Cooper et al. BMJ. .

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.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Different methods of administration of local anaesthetic for outpatient hysteroscopy
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Fig 2 Study selection process for systematic review of local anaesthetic for pain relief during outpatient hysteroscopy
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Fig 3 Jadad quality assessment of studies examining use of local anaesthetic for outpatient hysteroscopy
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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
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Fig 5 Incidence of vasovagal episodes in studies examining use of local anaesthetic for outpatient hysteroscopy
See this image and copyright information in PMC

Comment in

References

    1. Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA 2002;288:1610-21. - PubMed
    1. Royal College of Obstetricians and Gynaecologists. Standards for gynaecology. Report of a working party. RCOG Press, 2008.
    1. Yang J, Vollenhoven B. Pain control in outpatient hysteroscopy. Obstet Gynecol Surv 2002;57:693-702. - PubMed
    1. Tangsiriwatthana T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cochrane Database Syst Rev 2009;(1):CD005056. - PubMed
    1. Centre for Reviews and Dissemination (CRD). Systematic reviews: CRD’s guidance for undertaking reviews in health care. CRD, University of York, 2009.

MeSH terms