Pain relief during hysterosalpingography: role of intracervical block.

PURPOSE: Hysterosalpingography (HSG) is an important tool for evaluation of tubal factors in infertility. It does not require anesthesia but can be a painful procedure. Thus, this study was undertaken to establish the role of intracervical block as pain relief modality for HSG.

METHODS

This prospective, randomized study included hundred women attending the Department of Obstetrics and Gynecology, at a tertiary care centre in India. They were divided randomly through a computer generated table into two groups of 50 women each. In the study group, women received intracervical block along with premedication whereas in the control group women received premedication alone. Each patient was asked to rate her pain at six different points of time (T1-T6) during HSG using Visual analogue scale (VAS) and Verbal descriptive score. The difference in pain scores amongst the two groups was analyzed using independent t test.

RESULTS

Reduction of pain was observed from placement of tenaculum till end of procedure (T3-T6) with intracervical block (p < 0.05). Pain remained at a statistically lower level during the most painful steps i.e. traction of the cervix (VAS: 2.080.49 cm, 95 % C I 1.18-2.98 vs. 4.21.15 cm, 95 % CI 3.3-5.1, p = 0.001) and with the insertion of dye (VAS: 2.640.49, 95 % CI 1.7-3.5 vs. 5.121.45. 95 % CI 4.3-6.0, p = 0.001) in the study group as compared to control group.

CONCLUSION

Intracervical block can be offered to all women undergoing HSG to make the procedure less painful and thus improve the compliance.