Pain Intensity During Ultrasound Assessment of Uterine Cavity and Tubal Patency With and Without Painkillers: Prospective Observational Study.
To determine the pain intensity and incidence of mild to severe pain during the ultrasound assessment of the uterine cavity and tubal patency using saline, air and saline, and foam as contrasts with and without painkiller.



Prospective observational study (Canadian Task Force classification II-1).



Private clinic.



Three hundred infertile women who were consecutively submitted to uterine cavity and tubal patency assessment by ultrasound using saline, air, and foam in single exam between October 2012 and November 2013.



No painkillers were used until March 2013 when we started offering an effervescent codeine tablet containing paracetamol 500 mg and codeine phosphate 30 mg approximately 1 hour before the procedure.



Pain intensity measured with an 11-point (0-10) numerical rating scale and incidence of moderate/severe levels of pain (numerical rating scale > 3) during the main components of the procedure (speculum insertion, catheter insertion, saline infusion, air and saline infusion, foam infusion, and after the procedure [0 minutes, 15 minutes, 30 minutes, and 24 hours]) were assessed. The incidence of moderatesevere pain was significantly lower in women using painkillers considering any moment of the procedure: 49 of 175 (28%) versus 65 of 125 (52%); relative risk, .54; 95% confidence interval, .40-.72; p < .001; number needed to treat, 4. Less women presented with moderate/severe pain during air and saline compared with foam infusion: 31 of 300 (10%) versus 75 of 300 (25%); p < .001; relative risk, .41, 95% confidence interval, .28-.61.



The incidence of moderate/severe pain during the ultrasound assessment of the uterine cavity and tubal patency is common. Our results suggest that using paracetamol + codeine before the procedure reduces the pain level, but randomized controlled trials are required.
Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.
Inga
I
Ludwin
Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
Wellington P
WP
Martins
Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil; SEMEAR Fertilidade, Reproductive Medicine, Ribeirao Preto, Brazil.
Carolina O
CO
Nastri
Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland. Electronic address: ludwin@cm-uj.krakow.pl.
Artur
A
Ludwin
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D005186:Fallopian Tube Patency Tests / Q000379:methods; D005187:Fallopian Tubes / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000009:adverse effects* / Q000379:methods; D015994:Incidence; D007247:Infertility, Female / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010146:Pain / Q000145:classification / Q000188:drug therapy / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement; D011446:Prospective Studies; D012965:Sodium Chloride; D014463:Ultrasonography / Q000009:adverse effects*; D014599:Uterus / Q000000981:diagnostic imaging
D000700:Analgesics; D012965:Sodium Chloride
Acetaminophen; Fallopian tube patency tests; HyCoSy; HyFoSy; Ultrasonography