Analgesia for Office Hysteroscopy: A Systematic Review and Meta-analysis

Abstract

Objective: To identify the most effective analgesia for women undergoing office hysteroscopy.

Data sources: We searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library from inception until August 2019 for studies that investigated the effect of different analgesics on pain control in office hysteroscopy.

Methods of study selection: We included randomized controlled trials that investigated the effect of analgesics on pain experienced by women undergoing diagnostic or operative hysteroscopy in an office setting compared with the control group.

Tabulation, integration, and results: The literature search returned 561 records. Twenty-two studies were selected for a systematic review, of which 16 were suitable for meta-analysis. There was a statistically significant reduction in pain during office hysteroscopy associated with preprocedural administration of nonsteroidal anti-inflammatory drugs (NSAIDs) (standardized mean difference [SMD] -0.72; 95% confidence interval [CI] -1.27 to -0.16), opioids (SMD -0.50; 95% CI -0.97 to -0.03), and antispasmodics (SMD -1.48; 95% CI -1.82 to -1.13), as well as with the use of transcutaneous electrical nerve stimulation (TENS) (SMD -0.99; 95% CI -1.67 to -0.31), compared with the control group. Moreover, similar reduction in pain was observed after office hysteroscopy: NSAIDs (SMD -0.55; 95% CI -0.97 to -0.13), opioids (SMD -0.73; 95% CI -1.07 to -0.39), antispasmodics (SMD -1.02; 95% CI -1.34 to -0.69), and TENS (SMD -0.54; 95% CI -0.95 to -0.12). Significantly reduced pain scores with oral NSAID administration during (SMD -0.87; 95% CI -1.59 to -0.15) and after (SMD -0.56; 95% CI -1.02 to -0.10) office hysteroscopy were seen in contrast to other routes. Significantly more adverse effects were reported with the use of opioids (p <.001) and antispasmodics (p <.001) when compared with the control group, in contrast to NSAIDs (p = .97) and TENS (p = .63).

Conclusion: Women without contraindications should be advised to take oral NSAIDs before undergoing office hysteroscopy to reduce pain during and after the procedure. TENS should be considered as an alternative analgesic in women with contraindications to NSAIDs.

Keywords: Ambulatory; Endoscopy; Pain control.