A randomized, single blind, placebo-controlled trial for the pain reduction during the outpatient hysteroscopy after ketoprofen or intravaginal misoprostol.
OBJECTIVE
To assess the efficacy of ketoprofen vs intravaginal misoprostol for pain relief during outpatient hysteroscopy.


METHODS
Prospective, randomized, single-blind, placebo-controlled clinical trial (Canadian Task Force classification I).


METHODS
Tertiary medical center.


METHODS
One hundred fifty women referred for hysteroscopy between January and October 2013.


METHODS
Women were randomized to receive vaginal misoprostol, 400 μg, with 100 mL of 5% intravenous glucose (misoprostol arm); intravenous ketoprofen, 50 mg/mL, in 100 mL 5% glucose with intravaginal placebo (ketoprofen arm); or vaginal placebo tablets, 100 mL 5% intravenous glucose (placebo arm) before outpatient hysteroscopy.


RESULTS
A visual analog scale (VAS) was used for 1-dimensional pain assessment. Patients were asked to mark a VAS score before, during, and at 5 and 15 minutes after the procedure. Median VAS scores during and directly after the anesthesia-free hysteroscopy were significantly lower in the misoprostol group than in the ketoprofen (p = .02) or placebo (p = .006) groups. There were no statistical differences between the 3 arms in median VAS score assessed at 15 minutes after the procedure (p = .16). There were no differences in procedure time between groups (p = .16).


CONCLUSIONS
When administrated 4 hours before the procedure, 400 μg vaginal misoprostol seems to reduce the pain during and immediately after hysteroscopy. The effect does not depend on patient age, hormone status, parity, or type of outpatient hysteroscopy (operative or diagnostic).
Department of Obstetrics, Women's Diseases, and Oncogynecology, Central Clinical Hospital of Ministry of Interior and Administration; Center for Reproductive Health.
Tadeusz
T
Issat
Department of Obstetrics, Women's Diseases, and Oncogynecology, Central Clinical Hospital of Ministry of Interior and Administration; Center for Reproductive Health.
Jaroslaw
J
Beta
Department of Obstetrics, Women's Diseases, and Oncogynecology, Central Clinical Hospital of Ministry of Interior and Administration.
Malgorzata A
MA
Nowicka
Department of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland.
Tomasz
T
Maciejewski
Department of Obstetrics, Women's Diseases, and Oncogynecology, Central Clinical Hospital of Ministry of Interior and Administration; Center for Reproductive Health. Electronic address: jakimiuk@yahoo.com.
Artur J
AJ
Jakimiuk
D000282:Administration, Intravaginal; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods; D007660:Ketoprofen / Q000008:administration & dosage*; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage*; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016595:Misoprostol; D007660:Ketoprofen
Ketoprofen; Misoprostol; NSAIDs; Office hysteroscopy; Outpatient hysteroscopy