الفهرس 
HYSTEROSCOPYOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
Abstract
O
utpatient hysteroscopy in the office setting is often the preferred procedure for diagnosis of intrauterine pathology and abnormal uterine bleeding, as well as for therapeutic operative treatment and transcervical sterilization. It is desirable to attempt to perform as many procedures as possible with office hysteroscopy, as long as they take place in a safe and effective fashion.
Office hysteroscopy is a diagnostic and operative technique with many advantages compared with operating room-based hysteroscopy: it does not require hospital admission, preparatory tests, and general or regional anesthesia. Importantly, it has decreased postsurgical recovery period, global cost of the procedure, and rate of complications such as cervical tears, and uterine perforation. However, the most common adverse event and reason for procedure failure is pain.
Non-steroidal anti-inflammatory drugs (NSAIDs) are systemic analgesics inhibit the cyclooxygenase (COX) enzyme, thus reduce prostaglandins release. Although they are effective in decreasing pain in some gynecologic procedures. It was associated to pain reduction.
The aim of the present study was to assess the analgesic effect of diclofenac dissolving tablets in pain perception during and after outpatient diagnostic hysteroscopy without anaesthesia.
This was a Prospective, double blinded, Randomized placebo - Controlled clinical trial, conducted at outpatient hysteroscopy clinic of early cancer detection unit (ECDU) of Ain Shams maternity hospitals on 60 women divided into 2 groups: group I (Diclofenac group): included 30 women received a 50-mg oral dissolving diclofenac potassium tablet, group II (Placebo group): included 30 women received a placebo tablet of the same appearance.
Eighty women had an indication for diagnostic outpatient hysteroscopy. Twenty patients were excluded (Fifteen patients did not meet our criteria and five patients refused to take the drugs) and Sixty patients included in our criteria.
The main results of the study revealed that:
• We found that the mean age of Diclofenac group was (28.3±5.6) and placebo group: (27.7±4.4) and BMI in diclofenac group (27.4±3.7) and placebo group (27.6±3.6). There was statistically insignificant difference between two studied groups regarding age (years), BMI (kg/m2), race, duration of marriage (years) and socioeconomic class.
• There was statistically insignificant difference between two studied groups regarding gravidity/previous abortions.
• There was statistically insignificant difference between two studied groups regarding comorbidities including hypothyroidism, PCO, hypertension, asthma and CHD.
• We found that the main clinical presentation was failure to conceive in diclofenac group:30(100%) and placebo group:30(100%). There was statistically insignificant difference between two studied groups regarding clinical presentation including AUB, Irregular menses, Follow-up for uterine adhesions and recurrent pregnancy loss and
• We found that normal hysteroscopic findings were the major findings. in diclofenac group:11(36.7%) and placebo group:14(46.7)%.
• We found that pain scores including VAS during hysteroscopy (p=0.139) and VAS after hysteroscopy (p=0.306).There was statistically insignificant difference between two studied groups regarding Pain scores.
• There was statistically insignificant difference between two studied groups regarding side effects including bad medication taste, vomiting and failed procedure.
• The use of diclofenac pottasium administration 1 hour before office hysterscopy over placebo is not effective & failed to decrease the pain during hysteroscopic procedures.
• Diclofenac appear to be ineffective in reliving pain during OH.
CONCLUSION
• Diagnostic hysteroscopy is a painful procedure even when preformed with atraumatic technique by experienced surgeons so it is important to use anesthesia not analgesia during the procedure.
• The use of diclofenac pottasium administration 1 hour before office hysterscopy over placebo is not effective & failed to decrease the pain during hysteroscopic procedures.
RECOMMENDATIONS
• Although outpatient hysteroscopy is simple and safe procedure but most of the patients required strong analgesia or anaesthesia.
• Diclofenac appear to be ineffective in reliving pain during outpatient hysteroscopy.
• We recommend to use stronger analgesia and or anaesthesia as most of the patient cannot tolerate pain.