Pain relief in hysterosalpingography. A comparison of analgesics. The use of intrauterine lidocaine to minimize pain during hysterosalpingography: a randomized trial. Transcervical intrauterine topical local anesthetic at hysterosalpingography: a prospective, randomized, double-blind, placebo-controlled trial. Paracetamol as a prophylactic analgesic for hysterosalpingography: a double blind randomized controlled trial. Reduction of pain following hysterosalpingogram by prior analgesic administration. Intrauterine lidocaine gel application for pain relief during and after hysterosalpingography.
Hysterosalpingography provides important information in the evaluation of infertility but is generally considered an uncomfortable and painful procedure. We evaluated various analgesics for decreasing or eliminating the discomfort from this procedure. Two types of analgesia were required to give maximum pain relief during and after the examination in the 180 patients evaluated. The best results were achieved with a combination of naproxen sodium, 550 mg, given orally two hours before the examination, and 20% benzocaine, applied to the cervix. A hysterosalpingogram is an integral part of the evaluation of infertility but is often painful. Intrauterine anesthesia may help to alleviate the discomfort associated with this procedure.
                We conducted a randomized, double-blinded, placebo-controlled trial of intrauterine lidocaine in women undergoing hysterosalpingography (HSG). All women were instructed to take a nonsteroidal analgesic before the hysterosalpingogram. Patients received 3 mL of buffered 2% lidocaine solution or 0.9% normal saline instilled into the uterus before HSG. The primary outcome was the degree of pain experienced documented via 10-cm visual analogue pain scales. Systematic assessments of discomfort were also collected by the attending physician, radiology technician, and radiology physician.
                Sixty-four patients were randomly assigned to placebo and 63 women were randomly assigned to the lidocaine group. There were no differences in mean age, race, parity, or history of dysmenorrhea or chronic pelvic pain. There were no differences in the pain scores at baseline, during, or after the study procedure between the 2 groups. Peak pain scale scores associated with the procedure were 5.3 +/- 0.4 in both the placebo and study groups. In addition, assessments of patient discomfort revealed no significant differences between the 2 groups.
                We found no difference in pain between the intrauterine-lidocaine and placebo groups. Intrauterine lidocaine does not appear to be effective in decreasing pain in women undergoing HSG.
                I To assess whether transcervical intrauterine topical instillation of a local anesthetic agent reduces pain at hysterosalpingography.
                Prospective, randomized, double-blind, placebo-controlled study.
                Department of reproductive medicine at a university teaching hospital.
                One hundred ten women undergoing hysterosalpingography (HSG).
                Subjects were randomized to receive either 2 mL of 2% plain lignocaine or 2 mL of 0.9% sodium chloride solution (placebo) topically into the uterine cavity before the HSG was performed.
                The degree of lower abdominal pain experienced both during the injection of contrast media at HSG and 10 minutes after the procedure using a 20-cm visual analogue scale (VAS) and a four-point verbal descriptor scale (VDS).
                There was no difference in pain scores between lignocaine and placebo during the HSG. However, at 10 minutes after the HSG, subjects receiving lignocaine experienced more pain than those on placebo.
                Transcervical intrauterine topical instillation of 2 mL of 2% plain lignocaine does not reduce pain during HSG and may lead to increased pain immediately after the procedure. To evaluate the effectiveness of paracetamol as a prophylactic analgesic for hysterosalpingography (HSG).
                A prospective double blind randomized controlled trial comparing one 1 g of paracetamol (SmithKline Beecham, Brentford, U.K.) to placebo taken 30 min before HSG. One hundred consecutive out-patients were studied prospectively. The analgesic effectiveness during the procedure and at 24 h and 1 week post procedure was analysed by a postal pain score questionnaire. Additional data on the ethnicity of the patient, sex and level of experience of the radiologist performing the hysterosalpingogram, the parity of the patient, the ease of the procedure, and whether pathology was identified were also recorded.
                Eighty-eight patients (88%) replied, 39 (44%) received paracetamol and 49 placebo (56%). During the procedure 3/39 (7%) of women in the paracetamol group were pain-free compared to 9/49 (18%) in the placebo group, which was not significant (P = 0.11). At 24 h, 15/39 (38%) of women in the paracetamol group were pain-free compared to 20/49 (41%) in the placebo group, which was not significant (P = 0.82). At 1 week, 27/39 (69%) of women in the paracetamol group were pain-free compared to 29/49 (59%) in the placebo group, which was not significant (P = 0.33). No significant difference in mean pain scores was determined during the procedure (P = 0.91), or at 24 h post procedure (P = 0.94). Similarly, no difference in mean pain scores was identified with regard to the ethnicity of the patient, the sex of the radiologist performing the procedure, the level of experience of the radiologist performing the procedure, or whether pathology was present or not. Difficult cannulations were associated with higher mean pain scores, however, there was no difference in mean pain scores between the paracetamol or placebo groups for both easy and difficult cannulations.
                Paracetamol is not effective as a prophylactic analgesic for HSG. If a prophylactic analgesic is considered necessary for pain relief during HSG we recommend that a non-steroidal anti-inflammatory drug (NSAID) is used. nan nan
There is little evidence of benefit in terms of pain relief of any of the interventions considered in this study during or immediately after HSG. However, there is limited evidence of pain reduction 30 minutes after the procedure. Further RCTs should consider the role of non steroidal antiinflammatories (NSAIDs) and intrauterine anaesthetic during HSG.