الفهرس | Only 14 pages are availabe for public view |
Abstract Summary ysteroscopy has become a standard investigation for a lot of gynecological cases and found to be effective in detecting intrauterine pathology and treating it . It is usually performed as an outpatient procedure under either local or no anesthesia It is associated with some degree of pain and carries a risk of a vaso-vagal reaction. Pain is the commonest reason for failure to complete the procedure. Although paracervical anesthesia is useful for local ablation of the cervix and suction evacuation of the uterus, it has not been shown to reduce pain during hysteroscopy in randomized trials suggesting that the use of local anesthesia may reduce the pain. Local anesthetic techniques are being used at an increasing rate in modern gynecology. The increased expense of hospital admission has caused many gynecologists to perform operative hystrescopy employing local anesthesia in offices and clinics. Direct cervical stromal infiltration or uterosacral ligament block have been most often used for operations on the uterine cervix and corpus; but these methods are seldom totally effective, they required expertise for consistent good results, and potentially toxic doses of anesthetic agents are required in these vascular areas where direct venous injection H Summary 60 and systemic toxicity are constant hazards.General anesthesia is discouraged, especially for more minor procedures because of the associated risks and attendant The aim of the current study is to compare between the effect of intracornual nerve block versus placebo in reducing pain & discomfort during operative hysteroscopy. The study was conducted at the Early Cancer Detection and Endoscopy Unit (Ain Shams University Hospital) where 58 patients fulfilling the criteria of the study was recruited from the gynecology outpatient clinic of the hospital. After enrollment, an informed written consent was taken from all participants before recruitment in the study and after explaining the purpose, possible risks and complications of different procedures carried out in the study. The patient were randomly categorized into two groups : group A : patients receive corneal nerve block using local anathesia during operative procedure. group B : patients receive placebo in the form of normal saline instead of local anathesia in the hystroscopic injection. Summary 61 29 patients underwent polypectomy. 10 patients underwent septal resection. 3 patients underwent missed IUD removal. Primary outcome: Pain reported during procedure via visual analogue scale (VAS) from 0 to 10. Secondary outcome : The need for postoperative analgesia (non-steroidal, opioids, paracetamol), duration of hospital stay. Pain experienced during the procedure (traction of cervix, introduction of hysteroscopy, during the procedure, on withdrawal and after procedure) was evaluated using VAS to assess the pain experienced during surgical procedures. In the current study, there was no statistically significant differences between women of both groups regarding age, body mass index or frequency distribution of type of hysteroscopic procedure. Visual analogue score for assessment of intra-operative pain was statistically significantly lower in the LA-ICOB group compared to the placebo-ICOB group. In the same context, the number of patients requiring extra analgesia (either as NSAIDs or opioid analgesics) was statistically significantly larger in the placebo-ICOB group compared to the LA-ICOB group. Summary 62 No statistically significant differences were found between both groups regarding duration of postoperative hospital stay. This study proved that the use of intracornual nerve block in operative hysteroscopy is both beneficial and effective in reducing pain and discomfort that could associate operative hysteroscopy procedure |