الفهرس 
HYSTEROSCOPYOnly 14 pages are availabe for public view
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Abstract
Office hysteroscopy is a technique that uses a thin tube and a tiny camera to view what is inside the uterus without making any incisions or requiring anesthesia. Various studies have considered office hysteroscopy as the gold standard diagnostic technique for endometrial pathology detection.
Diagnostic hysteroscopy is used to evaluate the endocervical canal, endometrial cavity, and tubal ostia. The procedure is often coupled with sight-directed biopsy or followed by endometrial curettage to evaluate for endometrial pathology.
The endometrial cavity is an empty cavity and requires distension to permit visualization. For optimum visualization, during hysteroscopy either fluid, mostly normal saline, or carbon dioxide gas is used to distend the empty endometrial cavity.
Normal saline is commonly suggested as the preferred medium for distension in outpatient hysteroscopy because it gives a better view and has been linked to fewer vasovagal episodes than carbon dioxide.
This study was aim to explore the effectiveness of warm saline (body temperature 37C) versus normal saline (room temperature) as a distension media in relieving pain in office hysteroscopy.
This was a randomized control trial conducted at Early Cancer Detection and Gynecological Endoscopy Unit, Maternity hospital, Ain Shams University on 100 women who underwent office hysteroscopy from 1st April 2021 to 30th October 2021.
Randomly, the study participants were distributed into two groups of equal number; group (A) which included 50 patients in whom warm saline (body temperature 37C) was infused inside the endometrial cavity during hysteroscopy, and group (B) which included 50 patients in whom normal saline (room temperature) were used during hysteroscopy.
In the current study ,No statistically significant differences were found between both groups in any of the studied confounding variables with P-value (>0.05), including age (p=0.808)., BMI (p= 0.401) , parity(p=0.616) , history of previous uterine surgeries (p=0.076), history of previous cervical surgeries (p=1.000) ,menopausal status (p=0.538), indications of the procedure (p=0.920) , clarity of view (p= 0.307), ease of entry (p=1.000) and rate of complications (p=1.000).
In the current study, Visual analogue scale at the end of the procedure was significantly higher in group B (6.88±1.60) compared to group A (5.86±1.86) with a p-value of 0.002. While no statistically significant difference was found between groups regarding pain scores 15 minutes after the procedure.
In the present study, patients in group A showed more statistically significant satisfaction than patients in group B with a p-value of (p= 0.009).
These findings indicated the superiority of warm saline to normal saline as regards pain relief.
In the current work, there was a statistically significant difference between the two groups according to the duration of the procedure “minutes” with a p-value (p<0.05). The highest value was found using warm saline.
CONCLUSION
This study was a randomized controlled trial to evaluate the effectiveness of warm saline (body temperature) distension media versus normal saline (room temperature) distension media in decreasing pain in office hysteroscopy.
We found that patients who used warm saline (body temperature) distension media complained statistically less pain at the end of the procedure and statistically showed more satisfaction than patients who used normal saline (room temperature) distension media.
However, there is no statistically significant difference between the two groups according to the Pain score 15min after the procedure.
And also, the Time taken to complete the procedure in minutes showed a statistically significant difference between the two groups with the highest value in patients who used warm saline distension media compared with a patient who used room temperature saline media.
RECOMMENDATIONS
We recommended the use of warm saline (37.5º) as distension media instead of room temperature saline as warm saline decrease pain at the end of the procedure and increases patient satisfaction.
Complementary studies with larger samples, different situations, and different places are needed for this subject
We also need to search about using combined methods with different types of analgesia at the same time as using warm saline media with (NSAIDs) together to decrease the pain and this needs more research.