Márlon de Freitas Fonseca1, Felipe V Sessa2, José Anacleto D Resende3, Camilla Gabriely S Guerra2, Claudio M Andrade4, Claudio P Crispi4. 1. Departments of Anesthesiology and Gynecology, Instituto Fernandes Figueira, Rio de Janeiro, Brazil. Electronic address: marlon@iff.fiocruz.br. 2. Departments of Anesthesiology and Gynecology, Instituto Fernandes Figueira, Rio de Janeiro, Brazil. 3. Departments of Anesthesiology and Gynecology, Instituto Fernandes Figueira, Rio de Janeiro, Brazil; Department of Urology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil. 4. Department of Gynecology, Centro de Video-Endoscopia, Rio de Janeiro, Brazil.
Abstract
STUDY OBJECTIVE: To identify predictors of unacceptable pain during office hysteroscopy without anesthesia. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: Teaching hospital. PATIENTS: Five hundred fifty-eight women aged 17 to 73 years. INTERVENTION: Elective office hysteroscopy without anesthesia. MEASUREMENTS AND MAIN RESULTS: Pain intensity was assessed via a verbal rating scale (VRS, 0-10). Pain was considered unacceptable when severe during the procedure (VRS ≥7) or moderate to severe at discharge (VRS ≥4). After preliminary statistical analysis, factors including diabetes, age ≤50 years, previous curettage, dyspareunia, severe dysmenorrhea, and hysteroscopist experience were selected to compose 2 binary multivariate models to predict unacceptable pain. As expected, hysteroscopist experience was protective against unacceptable pain during office hysteroscopy (p = .03; adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 41-96) and also at discharge (p = .002; adjusted OR, 0.48; 95% CI, 30-77). Severe dysmenorrhea was a significant risk factor for pain (cramps) at discharge (p < .001; adjusted OR, 3.07; 95% CI, 1.97-4.78). CONCLUSION: Women with severe dysmenorrhea will benefit from preemptive analgesia regardless of hysteroscopist level of experience because this condition significantly increased the occurrence of unacceptable cramps at discharge.
STUDY OBJECTIVE: To identify predictors of unacceptable pain during office hysteroscopy without anesthesia. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: Teaching hospital. PATIENTS: Five hundred fifty-eight women aged 17 to 73 years. INTERVENTION: Elective office hysteroscopy without anesthesia. MEASUREMENTS AND MAIN RESULTS:Pain intensity was assessed via a verbal rating scale (VRS, 0-10). Pain was considered unacceptable when severe during the procedure (VRS ≥7) or moderate to severe at discharge (VRS ≥4). After preliminary statistical analysis, factors including diabetes, age ≤50 years, previous curettage, dyspareunia, severe dysmenorrhea, and hysteroscopist experience were selected to compose 2 binary multivariate models to predict unacceptable pain. As expected, hysteroscopist experience was protective against unacceptable pain during office hysteroscopy (p = .03; adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 41-96) and also at discharge (p = .002; adjusted OR, 0.48; 95% CI, 30-77). Severe dysmenorrhea was a significant risk factor for pain (cramps) at discharge (p < .001; adjusted OR, 3.07; 95% CI, 1.97-4.78). CONCLUSION:Women with severe dysmenorrhea will benefit from preemptive analgesia regardless of hysteroscopist level of experience because this condition significantly increased the occurrence of unacceptable cramps at discharge.
Authors: Andréa Pegoraro; Marcelo Ettruri Santos; Jean Tetsuo Takamori; Waldemar de Almeida Pereira de Carvalho; Renato de Oliveira; Caio Parente Barbosa; Ângela van Nimwegen Journal: Einstein (Sao Paulo) Date: 2019-12-13
Authors: Giovanni Buzzaccarini; Luis Alonso Pacheco; Amerigo Vitagliano; Sergio Haimovich; Vito Chiantera; Péter Török; Salvatore Giovanni Vitale; Antonio Simone Laganà; Jose Carugno Journal: Medicina (Kaunas) Date: 2022-08-20 Impact factor: 2.948