Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy.
BACKGROUND
Office hysteroscopy with endometrial biopsy is usually the first investigation for abnormal uterine bleeding and other uterine diseases.


OBJECTIVE
To evaluate the effect of oral drotaverine with mefenamic acid on pain perception during hysteroscopy and endometrial biopsy and to compare it with that of paracervical block using 1% lignocaine and with that of intravenous sedation using diazepam with pentazocine.


METHODS
Outpatient gynecological department and open randomized trial.


METHODS
One hundred twenty women undergoing hysteroscopy and endometrial biopsy were randomized into 3 groups. Group I received tablet containing drotaverine hydrochloride (80 mg)+mefenamic acid (250 mg), group II received lignocaine paracervically and group III received intravenous diazepam. The intensity of pain during the procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed.


METHODS
Statistical analysis was performed using Kruskal-Wallis test, with the Bonferroni correction, the t test, and the chi2 test.


RESULTS
Groups were similar in age, parity, vaginal birth or relevant medical history. A statistically significant difference in pain scores was noted among the 3 groups during the procedure (group I, 4.13+/-1.28; group II, 5.93+/-1.26; group III, 5.58+/-1.51), (P<0.001); as well as 30 minutes later (group I, 1.78+/-0.89; group II, 2.53+/-0.81; group III, 2.23+/-0.94), (P<0.001) and 60 minutes later (group I, 1.2+/-0.46; group II, 1.98+/-0.83; group III, 1.68+/-0.75), (P<0.001). VAS at different time intervals among the groups was also statistically significant. No adverse effects were observed.


CONCLUSIONS
Oral drotaverine with mefenamic acid is effective in women undergoing hysteroscopy and endometrial biopsy.
Sharma
J B
JB
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India. jbsharma2000@gmail.com
Aruna
J
J
Kumar
Praveen
P
Roy
Kallol Kumar
KK
Malhotra
Neena
N
Kumar
Sunesh
S
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D000771:Anesthesia, Intravenous / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D003975:Diazepam / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D015907:Hysteroscopy / Q000379:methods*; D008528:Mefenamic Acid / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement; D010208:Papaverine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010423:Pentazocine / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
D000759:Adjuvants, Anesthesia; D000700:Analgesics; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008528:Mefenamic Acid; C005317:drotaverin; D010208:Papaverine; D003975:Diazepam; D010423:Pentazocine