title: Comparison of four different pain relief methods during hysterosalpingography: a randomized controlled study.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.forename: Bekir Serdar
authors.initials: BS
authors.lastname: Unlu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yilmazer
authors.forename: Gulengul
authors.initials: G
authors.lastname: Koken
authors.forename: Dagistan Tolga
authors.initials: DT
authors.lastname: Arioz
authors.forename: Ebru
authors.initials: E
authors.lastname: Unlu
authors.forename: Elif
authors.initials: E
authors.lastname: Dogan Baki
authors.forename: Cemile
authors.initials: C
authors.lastname: Kurttay
authors.forename: Osman
authors.initials: O
authors.lastname: Karacin
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage*; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D008012:Lidocaine
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