Effectiveness of warm saline for pain relief in office hysteroscopy: A prospective randomized control trial

Abstract

Background: Office Hysteroscopy is often considered the gold standard in diagnosing intrauterine pathology. Pain during the procedure usually is the cause of failure in Office Hysteroscopy. Various techniques have been developed and employed for making the patient more comfortable during the procedure. The main objective of this study was to compare pain intensity and degree of satisfaction reported by patients undergoing Office Hysteroscopy using saline solution kept at room temperature (control group) and saline solution warmed up to 410C (test group). Methods: 110 patients were recruited for the study, 55 in test group and 55 in control group as per inclusion criteria. A computer generated randomization sequence was used for allocation of group. Ambient temperature was set at 260C and an automated fluid warmer was used for heating the saline medium to 410C for test group. Office Hysteroscopy was performed by vaginoscopic technique using a 3.2mm Compact Hysteroscope. VAS (Visual Analogue Scale) score was assessed during the procedure and 15 minutes later. Results: VAS score during the procedure was found to be significantly lower in warm saline group (2.64+1.62) as compared to placebo (4.90+1.90); p = 0.001. Moreover, the VAS score at 15 minutes post-procedure was found to be significantly lower in the warm saline group (1.82+0.39) as compared to room temperature saline (2.94+0.96); p = 0.001. Warm saline as distension medium had a significant positive effect on satisfaction level of patients; 78% (n=39) women in warm saline group expressed their willingness to undergo the procedure again, if required, versus 23.5% (n=12) in room temperature saline; p = 0.001. Also, 74% (n=37) women in warm saline group would recommend the procedure to their friends and relatives versus 31.3% (n=16) in room temperature saline; p = 0.001. Conclusions: Using warm saline (410C) as distension medium for Office Hysteroscopy significantly reduces pain during and after the procedure. Moreover, patient satisfaction is better with warm saline as distension medium.