الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Outpatient hysteroscopy is a clinical procedure that is used for several diagnostic and therapeutic purposes. However, the most common adverse event and reason for procedure failure is pain. Several strategies were developed to manage pain during outpatient hysteroscopy. These methods range from various pharmacological agents as non-steroidal anti- inflammatory drugs (NSAIDs), opioids, and local anesthetics to non- pharmacological interventions as hypnosis, heat, and transcutaneous electric nerve stimulation (TENS).
Because of the prevalence and burden of pain in this procedure, determination of the best analgesic methods would inform clinical practice and improve patient care. Therefore, we conducted the present study in order to compare the efficacy of transcervical intrauterine lidocaine instillation versus rectal diclofenac in reducing pain during outpatient hysteroscopy.
The present study was a randomized, comparative, trial that included 200 female patients who underwent outpatient hysteroscopy at office hysteroscopy room at early cancer detection unit of Ain Shams Maternity
Hospital. The patients were randomly allocated to receive transcervical intrauterine instillation of 5ml 2% lidocaine or 100mg rectal diclofenac.
In terms of demographic characteristics of the included patients, the mean age was 28.58 ± 4.87 and the mean BMI was 25.97 ± 2.46 kg/m2.
In the present study, the most common cause for undergoing infertility, followed by menorrhagia and irregular uterine bleeding. In addition, the most common findings was submucous fibroid, endometrial polyp, and intrauterine adhesion.
Regarding the primary outcome of the present study, we found that the 100mg rectal diclofenac was more effective than intrauterine instillation of 5ml 2% lidocaine for pain relief during outpatient hysteroscopy. Both drugs was tolerable with no observed adverse events.
In the present study, we found that the hysteroscopy-associated pain was correlated with patient’s age only.
The present trial has a number of strength points. Patients were randomly allocated to the studied groups which potentially limit the selection bias. In addition, the investigators were blinded to allocated treatment which might have limited the assessment bias. We acknowledge that the present study has some limitations. The study was a single-center experience and therefore the results cannot be generalized to the general population.
In conclusion, both rectal diclofenac intrauterine instillation of a topical anesthetic is easy, relatively painless and promising for adequate analgesia during office hysteroscopy. The present study showed that rectal diclofenac was more effective than local anesthetic in pain relief during outpatient hysteroscopy. This technique may be ideal for outpatient diagnostic hysteroscopy. However, further well-designed studies are still needed to confirm our finding.