title: Office diagnostic and operative hysteroscopy using local anesthesia only: an analysis of patient reported pain and other procedural outcomes.
abstract: OBJECTIVE
  To evaluate the effectiveness of a multimodality local anesthetic protocol for office diagnostic and operative hysteroscopy.
  
  
  METHODS
  Retrospective cohort study (Canadian Task Force classification II-3).
  
  
  METHODS
  Academic community-based institution.
  
  
  METHODS
  Five hundred sixty-nine women undergoing 639 office-based diagnostic or operative hysteroscopic procedures.
  
  
  METHODS
  Multimodality local anesthetic protocol addressing vagina, cervix, paracervical region, and endometrial cavity.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Electronic address: Sanaz.Keyhan@dm.duke.edu.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Keyhan
authors.affiliation: 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.
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Munro
mesh_terms: D000026:Abortion, Habitual / Q000209:etiology* / Q000473:pathology; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics; D000772:Anesthesia, Local / Q000191:economics / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000191:economics / Q000379:methods; D007247:Infertility, Female / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D061214:Patient Safety; D017060:Patient Satisfaction; D011247:Pregnancy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014592:Uterine Hemorrhage / Q000209:etiology* / Q000473:pathology
keywords: Hysteroscopic procedures; Hysteroscopy; Local anesthesia; Office hysteroscopy