Charoenkwan Kittipat, Nantasupha Chalaithorn
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Obstet Gynaecol Res. 2020 Jan;46(1):9-30. doi: 10.1111/jog.14152. Epub 2019 Oct 30.
To review effectiveness of methods for reducing pain during endometrial biopsy.
PubMed, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases were searched for randomized controlled trials that examined effectiveness of pain control methods for endometrial biopsy. Risk of bias was assessed from sequence generation, allocation concealment, blinding, incomplete outcome data and selective outcome reporting. Heterogeneity was examined from forest plot, statistical tests of homogeneity, and I statistic. For meta-analysis of pain scores, weighted mean difference with 95% confidence interval (CI) were estimated.
Twenty-six studies were included in the review. Marginally significant reduction in the pain score during the procedure in participants with intrauterine lidocaine relative to control was observed (mean difference [MD] -1.31, 95% confidence interval [CI] -2.70 to 0.09, P = 0.07). Subgroup analysis showed that in studies that used low-pressure suction devices, intrauterine lidocaine was associated with statistically significant reduction in pain during the procedure (MD -2.22, 95% CI -3.72 to -0.73, P = 0.004). There was a significantly lower pain score during biopsy in the anesthetic spray group compared to control (MD -0.96, 95% CI -1.53 to -0.39, P = 0.001). Significant heterogeneity on types of intervention and outcome measures among studies that examined paracervical block and nonsteroidal anti-inflammatory drugs (NSAID) was observed. However, paracervical block and NSAID were associated with significant pain reduction compared to placebo in most of the related studies.
Intrauterine anesthetics, anesthetic cervical spray, paracervical block and oral NSAID provide effective pain control during endometrial biopsy.
回顾子宫内膜活检时减轻疼痛方法的有效性。
检索PubMed、Scopus、Cochrane对照试验中央注册库和ClinicalTrials.gov数据库，查找检验子宫内膜活检疼痛控制方法有效性的随机对照试验。从序列生成、分配隐藏、盲法、不完整结果数据和选择性结果报告方面评估偏倚风险。通过森林图、同质性统计检验和I统计量检查异质性。对于疼痛评分的荟萃分析，估计加权平均差及95%置信区间（CI）。
该综述纳入了26项研究。观察到子宫内注射利多卡因的参与者在操作过程中的疼痛评分相对于对照组有轻微显著降低（平均差[MD] -1.31，95%置信区间[CI] -2.70至0.09，P = 0.07）。亚组分析表明，在使用低压吸引装置的研究中，子宫内注射利多卡因与操作过程中疼痛的统计学显著降低相关（MD -2.22，95% CI -3.72至 -0.73，P = 0.004）。与对照组相比，麻醉喷雾组在活检期间的疼痛评分显著更低（MD -0.96，95% CI -1.53至 -0.39，P = 0.001）。在检查宫颈旁阻滞和非甾体抗炎药（NSAID）的研究中，观察到干预类型和结果测量方面存在显著异质性。然而，在大多数相关研究中，与安慰剂相比，宫颈旁阻滞和NSAID与疼痛显著减轻相关。
子宫内麻醉剂、麻醉宫颈喷雾、宫颈旁阻滞和口服NSAID在子宫内膜活检期间可提供有效的疼痛控制。
