Goldstein Akavia Tal, Segev Yakir, Balan Edith, Siegler Efraim
Department of Pediatrics (Department B), Schneider's Children Medical Center, Petah Tiqva, Israel.
Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.
Aust N Z J Obstet Gynaecol. 2018 Dec;58(6):681-685. doi: 10.1111/ajo.12784. Epub 2018 Feb 7.
Cervical punch biopsies are a common ambulatory procedure, performed routinely by gynaecologists. The aim of the present study was to assess the efficacy of forced coughing as a pain-reducing technique during cervical punch biopsy compared to a control group.
The study was a prospective randomised-control trial. The study group comprised 90 women who underwent cervical punch biopsies during investigation of abnormal Pap test results. The women were randomly assigned to 'cough' and control groups. Pain was measured on a 10 cm visual analogue scale (VAS) during different stages of the procedure.
VAS pain score during biopsies was significantly lower in the 'cough' group. The median pain level in the 'cough' group was 1.5, compared to 4.0 in the control group. Eighty percent of the women in the 'cough' group reported a pain level of 2.0 or less compared to 40% of the women in the 'control' group (P = 0.0002). In the second biopsy, 69% of the women reported VAS ≤ 2.0 in the cough group compared to 28% of the patients in the control group. Forced coughing was shown both to reduce anxiety regarding the prospect of future cervical procedures and to decrease patients' desires for future pain management. This was true for 32% of the women in the 'control' group compared to 12% of the women in the 'cough' group (P = 0.05).
Forced coughing provides significant pain relief during cervical punch biopsy and reduces the patients' fears and desires for pain medications in future procedures.
宫颈活检是一种常见的门诊手术，通常由妇科医生进行。本研究的目的是评估与对照组相比，用力咳嗽作为一种减轻宫颈活检疼痛的技术的效果。
本研究是一项前瞻性随机对照试验。研究组包括90名在巴氏试验结果异常检查期间接受宫颈活检的女性。这些女性被随机分为“咳嗽”组和对照组。在手术的不同阶段，使用10厘米视觉模拟量表（VAS）测量疼痛程度。
“咳嗽”组活检期间的VAS疼痛评分显著较低。“咳嗽”组的中位疼痛水平为1.5，而对照组为4.0。“咳嗽”组80%的女性报告疼痛水平为2.0或更低，而“对照组”为40%（P = 0.0002）。在第二次活检中，咳嗽组69%的女性报告VAS≤2.0，而对照组为28%。用力咳嗽不仅能减轻对未来宫颈手术的焦虑，还能降低患者对未来疼痛管理的需求。“对照组”32%的女性是这样，而“咳嗽”组为12%（P = 0.05）。
用力咳嗽在宫颈活检期间能显著减轻疼痛，并减少患者对未来手术中止痛药的恐惧和需求。
