College of Medical and Dental Sciences (Drs. De Silva and Smith), University of Birmingham, Birmingham, UK.
Department of Obstetrics & Gynaecology (Dr. Mahmud), Walsall Manor Hospital, Walsall Healthcare NHS Trust, West Midlands, UK.
J Minim Invasive Gynecol. 2020 Jul-Aug;27(5):1034-1047. doi: 10.1016/j.jmig.2020.01.008. Epub 2020 Jan 23.
To identify the most effective analgesia for women undergoing office hysteroscopy.
We searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library from inception until August 2019 for studies that investigated the effect of different analgesics on pain control in office hysteroscopy.
We included randomized controlled trials that investigated the effect of analgesics on pain experienced by women undergoing diagnostic or operative hysteroscopy in an office setting compared with the control group.
TABULATION, INTEGRATION, AND RESULTS: The literature search returned 561 records. Twenty-two studies were selected for a systematic review, of which 16 were suitable for meta-analysis. There was a statistically significant reduction in pain during office hysteroscopy associated with preprocedural administration of nonsteroidal anti-inflammatory drugs (NSAIDs) (standardized mean difference [SMD] -0.72; 95% confidence interval [CI] -1.27 to -0.16), opioids (SMD -0.50; 95% CI -0.97 to -0.03), and antispasmodics (SMD -1.48; 95% CI -1.82 to -1.13), as well as with the use of transcutaneous electrical nerve stimulation (TENS) (SMD -0.99; 95% CI -1.67 to -0.31), compared with the control group. Moreover, similar reduction in pain was observed after office hysteroscopy: NSAIDs (SMD -0.55; 95% CI -0.97 to -0.13), opioids (SMD -0.73; 95% CI -1.07 to -0.39), antispasmodics (SMD -1.02; 95% CI -1.34 to -0.69), and TENS (SMD -0.54; 95% CI -0.95 to -0.12). Significantly reduced pain scores with oral NSAID administration during (SMD -0.87; 95% CI -1.59 to -0.15) and after (SMD -0.56; 95% CI -1.02 to -0.10) office hysteroscopy were seen in contrast to other routes. Significantly more adverse effects were reported with the use of opioids (p <.001) and antispasmodics (p <.001) when compared with the control group, in contrast to NSAIDs (p = .97) and TENS (p = .63).
Women without contraindications should be advised to take oral NSAIDs before undergoing office hysteroscopy to reduce pain during and after the procedure. TENS should be considered as an alternative analgesic in women with contraindications to NSAIDs.
确定在门诊宫腔镜检查中最有效的镇痛方法。
我们检索了 Medline、Embase、护理与联合健康文献累积索引和 Cochrane 图书馆，以获取自成立以来至 2019 年 8 月期间研究不同镇痛药对门诊宫腔镜检查中疼痛控制效果的研究。
我们纳入了比较镇痛药对在门诊环境下接受诊断性或手术性宫腔镜检查的女性疼痛影响的随机对照试验。
文献检索返回了 561 条记录。22 项研究被纳入系统评价，其中 16 项适合进行荟萃分析。与对照组相比，术前使用非甾体抗炎药（NSAIDs）（标准化均数差 [SMD] -0.72；95%置信区间 [CI] -1.27 至 -0.16）、阿片类药物（SMD -0.50；95% CI -0.97 至 -0.03）和抗痉挛药（SMD -1.48；95% CI -1.82 至 -1.13）以及经皮电神经刺激（TENS）（SMD -0.99；95% CI -1.67 至 -0.31）可显著降低门诊宫腔镜检查时的疼痛，此外，术后也观察到类似的疼痛减轻：NSAIDs（SMD -0.55；95% CI -0.97 至 -0.13）、阿片类药物（SMD -0.73；95% CI -1.07 至 -0.39）、抗痉挛药（SMD -1.02；95% CI -1.34 至 -0.69）和 TENS（SMD -0.54；95% CI -0.95 至 -0.12）。与对照组相比，口服 NSAIDs （SMD -0.87；95% CI -1.59 至 -0.15）和术后（SMD -0.56；95% CI -1.02 至 -0.10）期间的疼痛评分显著降低。与对照组相比，阿片类药物（p<.001）和抗痉挛药（p<.001）的不良反应报告明显更多，而 NSAIDs（p=0.97）和 TENS（p=0.63）则没有。
对于无禁忌证的女性，建议在门诊宫腔镜检查前口服 NSAIDs 以减轻手术过程中和手术后的疼痛。对于不能使用 NSAIDs 的女性，TENS 可作为一种替代镇痛方法。
