A new approach to office hysteroscopy compared with traditional hysteroscopy: a randomized controlled trial.
OBJECTIVE
To compare a "no touch" approach to diagnostic hysteroscopy without anesthesia with traditional diagnostic hysteroscopy after intracervical injection of mepivacaine hydrochloride 3%.


METHODS
A total of 130 women undergoing diagnostic hysteroscopy were included in the study and were randomized, using a computer-generated randomization list to one of two treatment groups in a ratio of 2:1. Eighty-three women underwent hysteroscopy without speculum, tenaculum, or anesthesia. Forty-seven women received intracervical anesthesia with 10 mL of 3% mepivacaine hydrochloride solution injected at two sites (3:00 and 9:00 positions) and underwent traditional hysteroscopy. Hysteroscopy was performed using a rigid 3.7-mm hysteroscope and a medium of 0.9% saline, and the image was transmitted to a screen visible to the patient. A visual analog scale (VAS) consisting of a 10-cm line was used to assess the intensity of pain experienced during and after the procedure. Overall patient satisfaction was assessed during, immediately after, 15 minutes later, and 3 days after hysteroscopy.


RESULTS
The mean pain score was significantly lower in the group without the use of speculum, tenaculum, or anesthesia (VAS1: 3.8+/-2.7 versus 5.34+/-3.23, P=.01; VAS2: 3.02+/-2.50 versus 4.57+/-3.30, P=.008). Patient satisfaction rate was similar in both groups.


CONCLUSIONS
Patients reported significantly less pain with the altered approach to diagnostic hysteroscopy compared with patients undergoing the traditional procedure with anesthesia. This new approach can therefore be considered as a useful hysteroscopic technique.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00319410
Sagiv
Ron
R
Department of Obstetrics and Gynecology, Epidemiology and Research Unit, Edith Wolfson Medical Center, Maccabi Women Health Care, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. sagivron@post.tau.ac.il
Sadan
Oscar
O
Boaz
Mona
M
Dishi
Michal
M
Schechter
Edwardo
E
Golan
Abraham
A
D000328:Adult; D000553:Ambulatory Care; D000779:Anesthetics, Local / Q000008:administration & dosage; D002584:Cervix Uteri; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007267:Injections; D008619:Mepivacaine / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology
D000779:Anesthetics, Local; D008619:Mepivacaine