Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TG, UK; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TG, UK.
Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:206-210. doi: 10.1016/j.ejogrb.2024.09.002. Epub 2024 Sep 6.
Penthrox® (methoxyflurane) is a convenient, portable, self-administered disposable single-use handheld inhaler licenced as an emergency, rapid-onset, short-acting, analgesic in adult trauma patients. Outpatient hysteroscopy is one of the commonest procedures in contemporary gynecology but it can be associated with significant pain leading to poor patient experience and failed procedures. We evaluated the feasibility and acceptability of Penthrox® in women undergoing outpatient hysteroscopic procedures and its potential efficacy to reduce pain and improve patient experience.
We conducted a prospective observational cohort study on women undergoing hysteroscopy or other intrauterine procedures, such as coil fitting, endometrial biopsy, polypectomy, endometrial ablation and manual vacuum aspiration in an outpatient setting. Women were offered Penthrox® inhalers for pain control, instructed how to use it and asked to record the intra-procedural pain they expected and actually experienced using a 10 cm Visual Analogue Scale. The acceptability, side effects and ease of use of the Penthrox® device were also recorded.
122/146 (83.6 %) women chose to use Penthrox®. 116 out of the 122 (95.1 %) underwent an intrauterine procedure, including 59 hysteroscopic polypectomies and 34 global endometrial ablations. The average pain expected during the procedure was 6.0 (SD = 2.8) and the pain experienced during the procedure was 5.1 (SD = 2.8). The intended procedure was completed in 117 (96 %) women. Penthrox® was considered easy to use by 118 (97 %) women and 111 (91 %) would use it again, although 22 (18 %) women would prefer general anaesthesia in the future. No adverse events occurred but 88 (72 %) women reported mild, self-limiting side effects.
Penthrox® appears safe, feasible and acceptable as a pain relief option during outpatient hysteroscopy and other intrauterine procedures. The effectiveness of Penthrox® should be evaluated against conventional pain control in an adequately powered multicentre randomised controlled trial.
戊烷脒（甲氧基氟烷）是一种方便、便携、可由患者自行管理的一次性手持式吸入器，作为一种急救、快速起效、短效的镇痛药，适用于成人创伤患者。门诊宫腔镜检查是当代妇科最常见的手术之一，但它可能会引起明显的疼痛，导致患者体验不佳和手术失败。我们评估了戊烷脒在接受门诊宫腔镜检查的女性中的可行性和可接受性，以及其减轻疼痛和改善患者体验的潜在疗效。
我们对在门诊环境下接受宫腔镜检查或其他宫内手术的女性（如宫内节育器放置、子宫内膜活检、息肉切除术、子宫内膜消融术和手动真空抽吸术）进行了前瞻性观察队列研究。女性可选择使用戊烷脒吸入器进行疼痛控制，我们向她们提供了使用说明，并要求她们使用 10cm 视觉模拟量表记录她们预期和实际经历的术中疼痛。还记录了戊烷脒设备的可接受性、副作用和易用性。
146 名女性中有 122 名（83.6%）选择使用戊烷脒。122 名女性中有 116 名（95.1%）进行了宫内手术，包括 59 例宫腔镜息肉切除术和 34 例全面子宫内膜消融术。预期手术期间的平均疼痛评分为 6.0（标准差=2.8），实际手术期间的疼痛评分为 5.1（标准差=2.8）。117 名女性（96%）完成了预期的手术。118 名女性（97%）认为戊烷脒易于使用，111 名女性（91%）会再次使用，尽管 22 名女性（18%）将来更喜欢全身麻醉。没有发生不良反应，但 88 名女性（72%）报告有轻度、自限性的副作用。
戊烷脒作为门诊宫腔镜检查和其他宫内手术的一种止痛选择，似乎安全、可行且可接受。应在充分有力的多中心随机对照试验中评估戊烷脒与常规止痛控制的有效性。
