Sanaz Keyhan1, Malcolm G Munro2. 1. Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Electronic address: Sanaz.Keyhan@dm.duke.edu. 2. Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Abstract
STUDY OBJECTIVE: To evaluate the effectiveness of a multimodality local anesthetic protocol for office diagnostic and operative hysteroscopy. DESIGN: Retrospective cohort study (Canadian Task Force classification II-3). SETTING: Academic community-based institution. PATIENTS: Five hundred sixty-nine women undergoing 639 office-based diagnostic or operative hysteroscopic procedures. INTERVENTIONS: Multimodality local anesthetic protocol addressing vagina, cervix, paracervical region, and endometrial cavity. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were numeric pain scores and rate of premature termination because of pain. Secondary outcomes included procedure pain and parity, delivery route, menopausal status, procedure type, and cost effect on procedure delivery. The overall mean (SD) pain score across 535 evaluable procedures was 3.7 (2.5). Patients undergoing operative hysteroscopy had a higher mean maximum pain score than did those who underwent diagnostic hysteroscopy only (4.1 vs 3.2; p < .001). There was no difference among women in different age groups; however, those with both cesarean section and vaginal delivery had scores higher than the mean (4.7 [0.4]; p < .001). The estimated cost savings was almost $2 million. CONCLUSION: Using a multimodality approach to local anesthesia, a broad spectrum of diagnostic and operative procedures can be performed successfully, comfortably, and inexpensively in the context of an office procedure room, without the need for procedural sedation.
STUDY OBJECTIVE: To evaluate the effectiveness of a multimodality local anesthetic protocol for office diagnostic and operative hysteroscopy. DESIGN: Retrospective cohort study (Canadian Task Force classification II-3). SETTING: Academic community-based institution. PATIENTS: Five hundred sixty-nine women undergoing 639 office-based diagnostic or operative hysteroscopic procedures. INTERVENTIONS: Multimodality local anesthetic protocol addressing vagina, cervix, paracervical region, and endometrial cavity. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were numeric pain scores and rate of premature termination because of pain. Secondary outcomes included procedure pain and parity, delivery route, menopausal status, procedure type, and cost effect on procedure delivery. The overall mean (SD) pain score across 535 evaluable procedures was 3.7 (2.5). Patients undergoing operative hysteroscopy had a higher mean maximum pain score than did those who underwent diagnostic hysteroscopy only (4.1 vs 3.2; p < .001). There was no difference among women in different age groups; however, those with both cesarean section and vaginal delivery had scores higher than the mean (4.7 [0.4]; p < .001). The estimated cost savings was almost $2 million. CONCLUSION: Using a multimodality approach to local anesthesia, a broad spectrum of diagnostic and operative procedures can be performed successfully, comfortably, and inexpensively in the context of an office procedure room, without the need for procedural sedation.
Authors: Salvatore Giovanni Vitale; Salvatore Caruso; Michal Ciebiera; Péter Török; Jan Tesarik; George Angelos Vilos; Aarathi Cholkeri-Singh; Ferdinando Antonio Gulino; Mohan Shashikant Kamath; Antonio Cianci Journal: Arch Gynecol Obstet Date: 2020-03-05 Impact factor: 2.344
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