Öz
Objectives: Hysteroscopy is a safe and simple procedure which is performed for evaluation and also for treatment of abnormal uterine bleeding, infertility and recurrent pregnancy loss. In this study we aimed to evaluate the efficacy of the local anesthesia techniques for office hysteroscopy.Material and Methods: This randomised, double-blinded and placebo-controlled trial was performed including the 100 patients who had hysterocopy procedure with the indications of habituel abortus, infertility and anormal uterine bleeding. The study was conducted at Zeynep Kamil Women and Children Diseases Training and Research Hospital, department of endoscopy in Istanbul, between January 2011 and December 2012.Results: VAS score at the insertion of vaginal speculum was significantly lower at the patients who had intrauterine lidocaine administration (p<0.05), there was no statistically significant difference between the other groups (p>0,05). When we compare the VAS scores at the hysteroscope insertion and during the procedure, between the groups, patients who had anesthesia rated lower scores. Also, the patients who had intrauterine lidocaine had lower VAS scores when compared to other groups. Although VAS score at the 30 minutes after the procedure was lower at the groups who had intrauterine lidocaine administration, this difference was not statistically significant.Conclusion: Intrauterine topical local anesthesia seems to be effective in decreasing the pain in women undergoing hysteroscopy.
Anahtar Kelimeler
Office hysteroscopy; Local anesthesia; PainCİLT: 45 YIL: 2014 SAYI: 3
Kaynakça
- MS Baggish; Operative Laparoscopy. JA Rock, JD Thompson (Eds.), Te Linde's Operative Gynecology (8th ed.), Lippincott Raven, Philadelphia (1997), pp. 415–442
- Wong AY, Wong K, Tang LC. Stepwise pain score analysis of the effect of local lignocaine on outpatient hysteroscopy: a randomized , double-blind, placebo-controlled trial. Fertil Steril, 2000;73(6):1234-7
- Soriano D, Ajaj S, Chuong T, Devai B, Fauconnier A, Darai E. Lidocaine spray and outpatient hysteroscopy: randomized placebo- controlled trial. Obstet Gynecol 2000;96(2): 661-4
- Lau WC, Tam WH, Lo WK, Yuen PM. A randomised double –blind placebo controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy. BJOG, 2000 7May; 107(5):610-3
- Zupi E, Luciano AA, Vali E, Marconi D, Maneschi F. The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy. Fertil Steril , 1995 Feb; 63(2):414-6
- Topical anaesthesia for diagnostic hysteroscopy and endometrial biopsy in postmenopausal women: a randomised placebo-controlled double-blind study. Authors Cicinelli E, Didonna T, Ambrosi G, Schönauer LM, Fiore G, Matteo MG. Journal Br J Obstet Gynaecol. 1997 Mar;104(3):316-9.
- Shankar M, Davidson A, Taub N, Habiba M. Randomised comparison of distension media for outpatient hysteroscopy. BJOG 2004;111(1):57-62.
- Kabil N, Tulandi T. A randomized trial of outpatient hysteroscopy with and without intrauterine anesthesia. J Minim İnvasive Gynecol 2008; 15(3): 308-10
OFİS HİSTEROSKOPİDE ANALJEZİ AMAÇLI LOKAL ANESTEZİ YÖNTEMLERİNİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI (Efficacy of Local Anesthesia for Office Hysteroscopy)
Öz
Giriş: Ofis histeroskopi anormal uterin kanama, infertilite, tekrarlayan gebelik kayıplarınının değerlendirilmesinde kullanılan önemli bir prosedürdür. Klinisyenlerin tecrübesinin artması ve teknolojik gelişmeler histeroskopi uygulama endikasyonlarını her gün daha da arttırmaktadır. Biz de çalışmamızda tanısal histeroskopi yapılan hastalarda lokal analjezi yöntemlerinin etkinliğini araştırmayı amaçladık.
Materyal ve Metod: Çalışmamıza hastanemiz etik kurulundan onay alındıktan sonra 2011 ile 2012 yılları arasında Zeynep Kamil Kadın ve Çocuk Hastalıkları Eiğtim ve Araştırma Hastanesi Kadın Doğum Endoskopi Kliniğinde infertilite, habitüel abortus ve anormal uterin kanama nedeniyle tanısal histeroskopi yapılan 100 hasta dahil edildi. Hastalar zarf üsülü ile randomize edilerek ,intrauterin lidokain uygulanan, intrauterin lidokain +servikal sprey uygulanan, servikal sprey uygulanan ve plasebo grubu olarak dört gruba ayrıldı. Verilerin analizinde SPSS 19.0 programı kullanıldı.
Bulgular: Bütün hasta gruplarında en fazla ağrının işlem sırasında olduğu ifade edildi. Işlem sırasında ( histereskop insersiyonu ve kavite değerlendirilmesi) kaydedilen VAS puanları intrauterin lidokain kullanılan iki grupta diğer gruplara kıyasla istatistiksel olarak daha düşük saptandı. Tenakulum uygulanması sırasında kaydedilen ağrı puanı servikal sprey kullanılan 2 grupta daha düşük saptandı.
Sonuç: Servikal sprey uygulanan hastalarda tenakulum takılması sırasında ağrının plaseboya kıyasla daha az olduğu izlendi. İntrauterin topikal anestezinin ise işlem sırasında ve işlemden sonra ağrıyı azalttığı tespit edildi.
ABSTRACT:
Objectives: Hysteroscopy is a safe and simple procedure which is performed for evaluation and also for treatment of abnormal uterine bleeding, infertility and recurrent pregnancy loss. In this study we aimed to evaluate the efficacy of the local anesthesia techniques for office hysteroscopy.
Material and Methods: This randomised, double-blinded and placebo-controlled trial was performed including the 100 patients who had hysterocopy procedure with the indications of habituel abortus, infertility and anormal uterine bleeding. The study was conducted at Zeynep Kamil Women and Children Diseases Training and Research Hospital, department of endoscopy in Istanbul, between January 2011- December 2012
Results: VAS score at the insertion of vaginal speculum was significantly lower at the patients who had intrauterine lidocaine administration (p<0,05), there was no statistically significant difference between the other groups (p>0,05) When we compare the VAS scores at the hysteroscope insertion and during the procedure, between the groups, patients who had anesthesia rated lower scores. Also, the patients who had intrauterine lidocaine had lower VAS scores when compared to other groups. Although VAS score at the 30 minutes after the procedure was lower at the groups who had intrauterine lidocaine administration , this difference was not statistically significant.
Conclusion: Intrauterine topical local anesthesia seems to be effective in decreasing the pain in women undergoing hysteroscopy
Key words: Office hysterescopy, pain, local anesthesia
Anahtar Kelimeler
Kaynakça
- MS Baggish; Operative Laparoscopy. JA Rock, JD Thompson (Eds.), Te Linde's Operative Gynecology (8th ed.), Lippincott Raven, Philadelphia (1997), pp. 415–442
- Wong AY, Wong K, Tang LC. Stepwise pain score analysis of the effect of local lignocaine on outpatient hysteroscopy: a randomized , double-blind, placebo-controlled trial. Fertil Steril, 2000;73(6):1234-7
- Soriano D, Ajaj S, Chuong T, Devai B, Fauconnier A, Darai E. Lidocaine spray and outpatient hysteroscopy: randomized placebo- controlled trial. Obstet Gynecol 2000;96(2): 661-4
- Lau WC, Tam WH, Lo WK, Yuen PM. A randomised double –blind placebo controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy. BJOG, 2000 7May; 107(5):610-3
- Zupi E, Luciano AA, Vali E, Marconi D, Maneschi F. The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy. Fertil Steril , 1995 Feb; 63(2):414-6
- Topical anaesthesia for diagnostic hysteroscopy and endometrial biopsy in postmenopausal women: a randomised placebo-controlled double-blind study. Authors Cicinelli E, Didonna T, Ambrosi G, Schönauer LM, Fiore G, Matteo MG. Journal Br J Obstet Gynaecol. 1997 Mar;104(3):316-9.
- Shankar M, Davidson A, Taub N, Habiba M. Randomised comparison of distension media for outpatient hysteroscopy. BJOG 2004;111(1):57-62.
- Kabil N, Tulandi T. A randomized trial of outpatient hysteroscopy with and without intrauterine anesthesia. J Minim İnvasive Gynecol 2008; 15(3): 308-10
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 6 Ağustos 2014 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 45 Sayı: 3 |
