Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis

Ahmed M. Abbas, Ahmed Samy, Abd El-Naser Abd El-Gaber Ali, Mustafa M. Khodry, Mohammad A M Ahmed, Mohammad AM Ahmed, Mahmoud I. El-Rasheedy, Khaled M. Abdallah, Abd-Elhalim Mohammed, Waleed H. Abdelbaky, Osama Kamal Raslan, Mahmoud Badawy, Mahmoud A. Badawy, Hossam H. Elktatny
Fertility and sterility · 2019 · vol. 112(1) , pp. 140–148.e12 · doi:10.1016/j.fertnstert.2019.03.028 · PMID:31056314 · W2942590329
Systematic review / meta-analysis OA: closed CC0 ⤵ 4 in-corpus citations
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Lidocaine spray was most effective for pain relief during and after endometrial biopsy, while naproxen sodium was most effective during hysteroscopy with endometrial aspiration.

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Abstract

OBJECTIVE: To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). DESIGN: Systematic review and network meta-analysis of randomized controlled trials. SETTING: Not applicable. PATIENT(S): Pre- or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. INTERVENTION(S): We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). MAIN OUTCOME MEASURE(S): The intensity of pain during, immediately after, and 10-30 minutes after procedure assessed by the 10-cm visual analog scale. RESULT(S): Lidocaine spray was the most effective medication for reducing pain during OEB (P-score = 0.83) and immediately after OEB (P-score = 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score = 1.00), followed by misoprostol plus lidocaine (P-score = 0.87). CONCLUSION(S): Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA.

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MeSH descriptors

Ambulatory Care Analgesics Biopsy Endometrium Hysteroscopy Pain Pain Management Uterine Hemorrhage Ambulatory Care Analgesics Analgesics Anesthetics, Local Anesthetics, Local Anti-Inflammatory Agents, Non-Steroidal Anti-Inflammatory Agents, Non-Steroidal Biopsy Endometrium Female Humans Hysteroscopy

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