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Pain Research and Management
Volume 20 (2015), Issue 2, Pages 107-111
Original Article

Comparison of Four Different Pain Relief Methods during Hysterosalpingography: A Randomized Controlled Study

Bekir Serdar Unlu,1 Mehmet Yilmazer,1 Gulengul Koken,1 Dagistan Tolga Arioz,1 Ebru Unlu,2 Elif Dogan Baki,3 Cemile Kurttay,1 and Osman Karacin1

1Department of Obstetrics and Gynecology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
2Department of Radiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
3Department of Anesthesiology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Hysterosalpingography (HSG) is the most commonly used method for evaluating the anatomy and patency of the uterine cavity and fallopian tubes, and is an important tool in the evaluation of infertility. The most frequent side effect is the pain associated with the procedure.

OBJECTIVES: To evaluate four analgesic methods to determine the most useful method for reducing discomfort associated with HSG.

METHODS: In the present prospective study, 75 patients undergoing HSG for evaluation of infertility were randomly assigned to four groups: 550 mg of a nonsteroidal anti-inflammatory drug (NSAID) (group 1); 550 mg NSAID + paracervical block (group 2); 550 mg NSAID + paracervical analgesic cream (group 3); or 550 mg NSAID + intrauterine analgesic instillation (group 4). A visual analogue scale was used to assess the pain perception at five predefined steps.

RESULTS: Instillation of the liquids used for HSG was found to be the most painful step of HSG, and this step was where the only significant difference among groups was observed. When comparing visual analogue scale scores, group 2 and group 3 reported significantly less pain than the other groups. Group 1 reported significantly higher mean ( ± SD) scores (7.2 ± 1.6) compared with groups 2 and 3 (4.7 ± 2.5 and 3.8 ± 2.4, respectively) (P<0.001). In addition, group 2 reported significantly less pain than group 4 (4.7 ± 2.5 versus 6.7 ± 1.8, respectively) (P<0.02).

CONCLUSIONS: For effective pain relief during HSG, in addition to 550 mg NSAID, local application of lidocaine cream to the posterior fornix of the cervix uteri and paracervical lidocaine injection into the cervix uteri appear to be the most effective methods.